Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ.
BACKGROUND
There is no clear consensus on the better therapeutic approach (endoscopic versus surgical) to choledocholithiasis. This study is a meta-analysis of the available evidence.


METHODS
A search of the Medline and ISI databases identified 12 studies that met the inclusion criteria for data extraction. The analysis was performed using a random-effects model. The outcome was calculated as an odds ratio (OR) or relative risk (RR) with 95 per cent confidence intervals (c.i.).


RESULTS
Outcomes of 1357 patients were studied. There was no significant difference in successful duct clearance (OR 0.85 (95 per cent c.i. 0.64 to 1.12); P = 0.250), mortality (RR 1.79 (95 per cent c.i. 0.66 to 4.83); P = 0.250), total morbidity (RR 0.89 (95 per cent 0.71 c.i. to 1.13); P = 0.350), major morbidity (RR 1.34 (95 per cent c.i. 0.92 to 1.97); P = 0.130) or need for additional procedures (OR 1.37 (95 per cent c.i. 0.82 to 2.29); P = 0.230) between the endoscopic and surgical groups. There was also no significant difference between the endoscopic and laparoscopic surgery groups.


CONCLUSIONS
Both approaches have similar outcomes, and treatment should be determined by local resources and expertise.
Clayton
E S J
ES
Department of Surgery, Christchurch Public Hospital, Christchurch, New Zealand.
Connor
S
S
Alexakis
N
N
Leandros
E
E
D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery*; D005704:Gallbladder; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D016896:Treatment Outcome