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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.

Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ

Review published: 2006.

Bibliographic details: Clayton E S, Connor S, Alexakis N, Leandros E.  Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ. British Journal of Surgery 2006; 93(10): 1185-1191. [PubMed: 16964628]

Quality assessment

The authors found no difference between surgery alone and endoscopy plus surgery for the management of choledocholithiasis in association with cholecystolithiasis, in outcomes including successful duct clearance, morbidity and mortality. The authors' conclusions appear to be supported by the data, but the lack of a validity assessment and incomplete reporting of review methods mean that the reliability of the conclusions is uncertain. Full critical summary


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.

CONCLUSION: Both approaches have similar outcomes, and treatment should be determined by local resources and expertise.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2012 University of York.

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