IDDF2018-ABS-0144 Single-operator peroral cholangioscopy in the treatment of difficult biliary stones: a systematic review and meta-analysis

Abstract

Background Current evidence supporting the utility of single-operator peroral cholangioscope (SOPOC) in the management of difficult bile duct stones is limited. We conducted the present systemic review and meta-analysis to evaluate the efficacy and safety of SOPOC in the treatment of difficult bile duct stones. Methods A search of studies up to January 2018 was acquired, using MEDLINE, EMBASE, the Cochrane Library and Google Scholar. Quality assessment of the studies was completed with a modified Newcastle-Ottawa Scale. The main outcomes of interest were single-session stone clearance rate, complete stone clearance rate and adverse events. We calculated the pooled proportions with random-effects models. Subgroup analyses were also performed based on SOPOC type. Results A total of 21 studies involving 2490 patients met the inclusion criteria. Average number of stones per patient was 2.2. Mean stone size was 17.4 mm. The pooled proportion of patients with single-session stone clearance was 72.5% (95% confidence interval [95% CI], 63.2%–80.9%). (Figure 1). Complete stone clearance was achieved in 94.7% (95% CI, 90.1%–98.1%) of patients with median endoscopic sessions of 2.0. The pooled adverse event rate was 5.5% (95% CI, 3.3%–8.2%). For SOPOC type SpyGlass and SpyGlass DS, single-session stone clearance rate was 69.1% (95%CI: 56.3%–80.6%) and 80.0% (95%CI: 75.8%–83.9%), respectively. Complete stone clearance rate was 92.8% (95%CI: 86.5%–97.5%) and 96.7% (95%CI: 88.1%–100.0%), respectively. Adverse events rate was 6.2% (95%CI: 3.4%–9.7%) and 3.0% (95%CI: 1.8%–4.4%), respectively. Conclusions SOPOC is an effective and safe management option for the treatment of bile duct stones when conventional methods have failed. More randomised controlled trials are required to elucidate the precise role of SOPOC during ERCP.