Abstract
ABSTRACT Introduction:Endoscopic removal of common bile duct stones has a high success rate ranging from 85% to 95%. Bile duct stones >15 mm are difficult and frequently require lithotripsy. Peroral cholangioscopy (POC) allows lithotripsy with similar success rates. Aim: To determine the efficacy and safety of cholangioscopy-guided lithotripsy used in the treatment of difficult to remove bile duct stones vs. conventional therapy. Methods:Search was based in Medline, Embase, Cochrane Central, Lilacs/Bireme. Studies enrolling patients referred for the removal of difficult bile duct stones via POC were considered eligible. Two analyses were carried out separately, one included randomized controlled trials (RCTs) and another observational studies. Results:Forty-six studies were selected (3 RTC and 43 observational). In the analysis there was no statistical significant difference between successful endoscopic clearance (RD=-0.02 CI: -0.17, 0.12/I²=0%), mean fluoroscopy time (MD=-0.14 CI -1.60, 1.32/I²=21%) and adverse events rates (RD=-0.06 CI: -0.14, 0.02/I²=0%), by contrast, the mean procedure time favored conventional therapy with statistical significance (MD=27.89 CI: 16.68, 39.10/I²=0%). In observational studies, the successful endoscopic clearance rate was 88.29% (CI95: 86.9%-90.7%), the first session successful endoscopic clearance rate was 72.7 % (CI95: 69.9%-75.3%), the mean procedure time was 47.50±6 min for session and the number of sessions to clear bile duct was 1.5±0.18. The adverse event rate was 8.7% (CI95: 7%-10.9%). Conclusions:For complex common bile duct stones, cholangioscopy-guided lithotripsy has a success rate that is similar to traditional ERCP techniques in terms of therapeutic success, adverse event rate and means fluoroscopy time. Conventional ERCP methods have a shorter mean procedure time.
Highlights
This is a systematic review with a meta-analysis that evaluates the use of peroral therapeutic cholangioscopy in the management of in difficult bile duct stones and is the first in the literature to include and perform meta-analyzis of randomized clinical trials
In terms of therapeutic success, mean fluoroscopy time and adverse event rate there was no statistical difference in the comparison between Peroral cholangioscopy (POC) and standard endoscopic retrograde cholangiopancreatography (ERCP) endoscopic methods in the management of difficult bile duct stones
In patients who had a prior ERCP with failure to remove stones, our analysis verified the benefit of cholangioscopy in the therapeutic success for the clearance of stones in the common bile duct
Summary
This is a systematic review with a meta-analysis that evaluates the use of peroral therapeutic cholangioscopy in the management of in difficult bile duct stones and is the first in the literature to include and perform meta-analyzis of randomized clinical trials. This is the first systematic review to include randomized controlled trials (RCTs) comparing peroral cholangioscopy (POC) vs conventional endoscopic retrograde cholangiopancreatography (ERCP) therapies used in the management of difficult bile duct stones Approximately 85-95% of gallstones in the bile duct can be managed with ERCP techniques, such as performing a sphincterotomy or using papillary balloon dilatation, extractor balloon, basket or mechanical lithotripter[67]. The primary objective of this systematic review and meta-analysis is to compare the therapeutic success of POC and standard ERCP endoscopic methods in the management of difficult bile duct stones. Secondary objectives include comparing the overall adverse event rate, mean procedure time and the mean fluoroscopy time of these techniques in the management of difficult bile duct stones
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