Cholecystectomy deferral in patients with endoscopic sphincterotomy

Vivian McAlister; Eric Davenport; Elizabeth Renouf

doi:10.1002/14651858.CD006233.pub2

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Guías
Temas

Revisiones y protocolos relacionados

Topics

Temas

Analysis 1.1

Comparison 1 Wait‐and‐see versus prophylactic cholecystectomy, Outcome 1 Mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1 Wait‐and‐see versus prophylactic cholecystectomy, Outcome 2 Biliary pain or cholecystitis.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1 Wait‐and‐see versus prophylactic cholecystectomy, Outcome 3 Pancreatitis.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

Comparison 1 Wait‐and‐see versus prophylactic cholecystectomy, Outcome 4 Recurrent jaundice or cholangitis.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.5

Comparison 1 Wait‐and‐see versus prophylactic cholecystectomy, Outcome 5 Major adverse events.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.6

Comparison 1 Wait‐and‐see versus prophylactic cholecystectomy, Outcome 6 Minor adverse events.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.7

Comparison 1 Wait‐and‐see versus prophylactic cholecystectomy, Outcome 7 Additional cholangiography (ERCP or PTC).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.8

Comparison 1 Wait‐and‐see versus prophylactic cholecystectomy, Outcome 8 Difficult cholecystectomy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

Comparison 2 Stratified by method of cholecystectomy, Outcome 1 Mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.2

Comparison 2 Stratified by method of cholecystectomy, Outcome 2 Biliary pain or cholecystitis.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.3

Comparison 2 Stratified by method of cholecystectomy, Outcome 3 Pancreatitis.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.4

Comparison 2 Stratified by method of cholecystectomy, Outcome 4 Recurrent jaundice or cholangitis.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.5

Comparison 2 Stratified by method of cholecystectomy, Outcome 5 Major adverse events.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.6

Comparison 2 Stratified by method of cholecystectomy, Outcome 6 Minor adverse events.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.7

Comparison 2 Stratified by method of cholecystectomy, Outcome 7 Additional cholangiography (ERCP or PTC).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.8

Comparison 2 Stratified by method of cholecystectomy, Outcome 8 Difficult cholecystectomy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.1

Comparison 3 Stratified by patient ASA class, Outcome 1 Mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.2

Comparison 3 Stratified by patient ASA class, Outcome 2 Biliary pain or cholecystitis.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.3

Comparison 3 Stratified by patient ASA class, Outcome 3 Pancreatitis.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.4

Comparison 3 Stratified by patient ASA class, Outcome 4 Recurrent jaundice or cholangitis.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.5

Comparison 3 Stratified by patient ASA class, Outcome 5 Major adverse events.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.6

Comparison 3 Stratified by patient ASA class, Outcome 6 Minor adverse events.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.7

Comparison 3 Stratified by patient ASA class, Outcome 7 Additional cholangiography (ERCP or PTC).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.8

Comparison 3 Stratified by patient ASA class, Outcome 8 Difficult cholecystectomy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Table 1. Actual cholecystectomy rate (prophylactic and therapeutic)

Trial	Wait‐and‐see: n/N	Prohylactic: n/N
Hammarstrom 1995	14/39	41/44
Targarona 1996	11/50	48/48
Suc 1998	56/92	102/102
Boerma 2002	22/59	44/49
Lau 2006	12/89	82/82
TOTAL	115/329	317/325

Table 1. Actual cholecystectomy rate (prophylactic and therapeutic)

Ir a la tabla de la revisión

Comparison 1. Wait‐and‐see versus prophylactic cholecystectomy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	1.78 [1.15, 2.75]

2 Biliary pain or cholecystitis Show forest plot	5	654	Risk Ratio (M‐H, Fixed, 95% CI)	14.56 [4.95, 42.78]

3 Pancreatitis Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	2.11 [0.39, 11.43]

4 Recurrent jaundice or cholangitis Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	2.53 [1.09, 5.87]

5 Major adverse events Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	0.60 [0.35, 1.02]

6 Minor adverse events Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	0.45 [0.22, 0.91]

7 Additional cholangiography (ERCP or PTC) Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	2.36 [1.29, 4.32]

8 Difficult cholecystectomy Show forest plot	5	654	Risk Ratio (M‐H, Fixed, 95% CI)	0.68 [0.39, 1.17]

Comparison 1. Wait‐and‐see versus prophylactic cholecystectomy

Ir a la tabla de la revisión

Comparison 2. Stratified by method of cholecystectomy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	1.70 [1.10, 2.64]

1.1 Open cholecystectomy & common bile duct exploration	3	383	Risk Ratio (M‐H, Fixed, 95% CI)	1.86 [1.03, 3.35]
1.2 Laparoscopic cholecystectomy after sphincterotomy	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	1.53 [0.79, 2.94]
2 Biliary pain or cholecystitis Show forest plot	5	654	Risk Ratio (M‐H, Fixed, 95% CI)	14.56 [4.95, 42.78]

2.1 Open cholecystectomy & common bile duct exploration	3	375	Risk Ratio (M‐H, Fixed, 95% CI)	11.09 [2.69, 45.79]
2.2 Laparoscopic cholecystectomy after spincterotomy	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	18.84 [3.66, 97.00]
3 Pancreatitis Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	2.11 [0.39, 11.43]

3.1 Open cholecystectomy & common bile duct exploration	3	383	Risk Ratio (M‐H, Fixed, 95% CI)	2.11 [0.39, 11.43]
3.2 Laparoscopic cholecystectomy after sphincterotomy	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Recurrent jaundice or cholangitis Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	2.53 [1.09, 5.87]

4.1 Open cholecystectomy & common bile duct exploration	3	383	Risk Ratio (M‐H, Fixed, 95% CI)	3.04 [0.47, 19.49]
4.2 Laparoscopic cholecystectomy after sphincterotomy	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	2.41 [0.94, 6.18]
5 Major adverse events Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	0.60 [0.35, 1.02]

5.1 Open cholecystectomy & common bile duct exploration	3	383	Risk Ratio (M‐H, Fixed, 95% CI)	0.73 [0.35, 1.53]
5.2 Laparoscopic cholecystectomy after sphincterotomy	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	0.47 [0.21, 1.04]
6 Minor adverse events Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	0.45 [0.22, 0.91]

6.1 Open cholecystectomy & common bile duct exploration	3	383	Risk Ratio (M‐H, Fixed, 95% CI)	0.28 [0.11, 0.73]
6.2 Laparoscopic cholecystectomy after sphincterotomy	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.32, 3.27]
7 Additional cholangiography (ERCP or PTC) Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	2.36 [1.29, 4.32]

7.1 Open cholecystectomy & common bile duct exploration	3	383	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.45, 1.94]
7.2 Laparoscopic cholecystectomy after sphincterotomy	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	20.40 [2.82, 147.51]
8 Difficult cholecystectomy Show forest plot	5	654	Risk Ratio (M‐H, Fixed, 95% CI)	0.68 [0.39, 1.17]

8.1 Open cholecystectomy & common bile duct exploration	3	375	Risk Ratio (M‐H, Fixed, 95% CI)	3.38 [0.14, 80.52]
8.2 Laparoscopic cholecystectomy after sphincterotomy	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	0.63 [0.36, 1.10]

Comparison 2. Stratified by method of cholecystectomy

Ir a la tabla de la revisión

Comparison 3. Stratified by patient ASA class

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	1.70 [1.10, 2.64]

1.1 Studies with inclusion of high‐risk patients (ASA IV or V)	3	383	Risk Ratio (M‐H, Fixed, 95% CI)	1.86 [1.03, 3.35]
1.2 Studies with exclusion of high‐risk patients (ASA IV or V)	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	1.53 [0.79, 2.94]
2 Biliary pain or cholecystitis Show forest plot	5	654	Risk Ratio (M‐H, Fixed, 95% CI)	14.56 [4.95, 42.78]

2.1 Studies with inclusion of high‐risk patients (ASA IV or V)	3	375	Risk Ratio (M‐H, Fixed, 95% CI)	11.09 [2.69, 45.79]
2.2 Studies with exclusion of high‐risk patients (ASA IV or V)	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	18.84 [3.66, 97.00]
3 Pancreatitis Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	2.11 [0.39, 11.43]

3.1 Studies with inclusion of high‐risk patients (ASA IV or V)	3	383	Risk Ratio (M‐H, Fixed, 95% CI)	2.11 [0.39, 11.43]
3.2 Studies with exclusion of high‐risk patients (ASA IV or V)	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Recurrent jaundice or cholangitis Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	2.53 [1.09, 5.87]

4.1 Studies with inclusion of high‐risk patients (ASA IV or V)	3	383	Risk Ratio (M‐H, Fixed, 95% CI)	3.04 [0.47, 19.49]
4.2 Studies with exclusion of high‐risk patients (ASA IV or V)	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	2.41 [0.94, 6.18]
5 Major adverse events Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	0.60 [0.35, 1.02]

5.1 Studies with inclusion of high‐risk patients (ASA IV or V)	3	383	Risk Ratio (M‐H, Fixed, 95% CI)	0.73 [0.35, 1.53]
5.2 Studies with exclusion of high‐risk patients (ASA IV or V)	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	0.47 [0.21, 1.04]
6 Minor adverse events Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	0.45 [0.22, 0.91]

6.1 Studies with inclusion of high‐risk patients (ASA IV or V)	3	383	Risk Ratio (M‐H, Fixed, 95% CI)	0.28 [0.11, 0.73]
6.2 Studies with exclusion of high‐risk patients (ASA IV or V)	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.32, 3.27]
7 Additional cholangiography (ERCP or PTC) Show forest plot	5	662	Risk Ratio (M‐H, Fixed, 95% CI)	2.36 [1.29, 4.32]

7.1 Studies with inclusion of high‐risk patients (ASA IV or V)	3	383	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.45, 1.94]
7.2 Studies with exclusion of high‐risk patients (ASA IV or V)	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	20.40 [2.82, 147.51]
8 Difficult cholecystectomy Show forest plot	5	654	Risk Ratio (M‐H, Fixed, 95% CI)	0.68 [0.39, 1.17]

8.1 Studies with inclusion of high‐risk patients (ASA IV or V)	3	375	Risk Ratio (M‐H, Fixed, 95% CI)	3.38 [0.14, 80.52]
8.2 Studies with exclusion of high‐risk patients (ASA IV or V)	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	0.63 [0.36, 1.10]

Comparison 3. Stratified by patient ASA class

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet