title: [A meta-analysis of preoperative versus intraoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones].
abstract: OBJECTIVE
  To compare the safety and efficiency of preoperative endoscopic sphincterotomy (POES) versus intraoperative endoscopic sphincterotomy (IOES) in patients with gallbladder and common bile duct stones.
  
  
  METHODS
  Multiple electronic databases were searched for prospective, randomized, controlled trials on the safety and effectiveness of POES versus IOES. And the outcome parameters of clearance rate, post-procedural complications and hospital stay were analyzed.
  
  
  RESULTS
  Five trials with 631 patients (POES, n=318; IOES, n=313) were analyzed. Although the overall rates of common bile duct stone clearance were similar between POES and IOES (RR 0.96, 95% CI: 0.91-1.01; P=0.13), the failure rate of CBD cannulation was significantly higher for IOES (RR 2.54, 95% CI: 1.23-5.26; P=0.01) during endoscopic retrograde cholangiopancreatography (ERCP). The pooled RR after POES for overall complication rates was similar to that for IOES (RR 1.56, 95% CI: 0.94-2.59; P=0.09). However, as compared with IOES, the RR risk of ERCP-related complications was significantly higher for POES (RR 2.27, 95% CI: 1.18-4.40, P=0.01). No significant inter-group differences existed in morbidity after laparoscopic cholecystectomy or subsequent conversion into open surgery. In subgroup analyses, the rates of hemorrhage, perforation, cholangitis, cholecystitis, and gastric ulceration showed no significant inter-group differences.
  
  
  CONCLUSIONS
  With regards to stone clearance and overall complication rate, POES is comparable to IOES in patients with gallbladder and common bile duct stones. However, IOES has a lowered incidence of ERCP-related pancreatitis and a shorter hospital stay.
authors.affiliation: Department of Surgery, Municipal People's Hospital, Dongyang 322100, China; Email: wangbin.china@163.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of Surgery, Municipal People's Hospital, Dongyang 322100, China.
authors.forename: Zhenjie
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Surgery, Municipal People's Hospital, Dongyang 322100, China.
authors.forename: Yunxiao
authors.initials: Y
authors.lastname: Lü
authors.affiliation: Department of Surgery, Municipal People's Hospital, Dongyang 322100, China.
authors.forename: Sicong
authors.initials: S
authors.lastname: Zhao
authors.affiliation: Department of Surgery, Municipal People's Hospital, Dongyang 322100, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Chen
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D003135:Common Bile Duct; D042882:Gallstones; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008657:Metabolic Clearance Rate; D010195:Pancreatitis; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic; D013276:Stomach Ulcer