Meta-analysis Of LC Combined With Intra-operative EST For The Management Of Cholecysto-choledocholithiasis

Objective:To systematically evaluate the effectiveness of laparoscopiccholecystectomy (LC) combined with either intra-operative or preoperativeendoscopic sphincterotomy (EST) for the management ofcholecysto-choledocholithiasis.Methods:The Cochrane Library, PubMed, EMbase and CBM data bases weresearched to identify randomized controlled trials (RCT) published betweenMay1990and May2012that compared the effectiveness of intra-operativeendoscopic sphincterotomy (IOES) during LC with preoperative endoscopicsphincterotomy (POES) followed by LC. Meta-analysis was performedusing the software RevMan5.0.Results:Five trials with631patients comparing IOES with POES were included.The meta-analysis revealed that, compared with POES, IOES significantlyreduced the rate of post-ERCP/EST complications [RR=0.46,95%CI (0.24, 0.88), P=0.02], especially for acute pancreatitis [RR=0.21,95%CI (0.06,0.71), P=0.01]. Hospital stay was shortened [WMD=-2.13，95%CI (-2.70，-1.56), P<0.00001] and total cost was reduced for patients in the IOESgroup [WMD=-352.61,95%CI (-637.18,-68.03), P=0.02]. There was nodifference between the two groups regarding the success rate of the surgery[RR=1.00,95%CI (0.94,1.07), P=0.99] and total complication [RR=0.64,95%CI (0.39，1.07), P=0.09].Conclusion:IOES is effective and safe as compared to POES, and thus it can beidentified as a preferable option for the treatment ofcholecysto-choledocholithiasis.