CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(02): E103-E109
DOI: 10.1055/s-0042-120412
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Sphincterotomy with endoscopic biliary drainage for severe acute cholangitis: a meta-analysis

Tarek Sawas
1   Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
,
Noura Arwani
1   Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
,
Shadi Al Halabi
2   Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
,
John Vargo
3   Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
› Author Affiliations
Further Information

Publication History

submitted21 January 2016

accepted after revision04 October 2016

Publication Date:
13 February 2017 (online)

Abstract

Aims To investigate the role of endoscopic sphincterotomy (ES) with endoscopic biliary drainage (EBD) in acute severe obstructive cholangitis management by performing a meta-analysis of controlled trials.

Method We searched PubMed and Embase for controlled studies that compared endoscopic drainage with ES versus Non-ES in acute obstructive cholangitis. Two reviewers selected the studies and extracted the data. Disagreement was addressed by a third reviewer. Heterogeneity of the studies was analyzed by Cochran’s Q statistics. A Mantel–Haenszel risk ratio was calculated utilizing a random effects model.

Results Four controlled studies met our inclusion criteria with 392 participants (201 ES, 191 Non-ES). The outcomes were drainage insertion success rate, drainage effectiveness, post drainage pancreatitis, bleeding, procedure duration, perforation, cholecystitis, and 30-day mortality. Drainage insertion success rate was identical in both groups (RR: 1.00, 95 %CI% 0.96 – 1.04). Effective drainage was not significantly different (RR: 1.11, 95 %CI 0.73 – 1.7). There was no significant difference in the incidence of pancreatitis post EBD between the ES and Non-ES groups at 3 % and 4 %, respectively (RR: 0.73, 95 %CI 0.24 – 2.27). However, there was a significant increase in post EBD bleeding with ES compared to Non-ES (RR: 8.58, 95 %CI 2.03 – 36.34). Thirty-day mortality was similar between ES and Non-ES groups at 0.7 % and 1 %, respectively (RR: 0.5, 95 %CI 0.05 – 5.28).

Conclusion Our findings show that EBD without ES is an effective drainage technique and carries less risk for post procedure bleeding. Patients who are critically ill and have coagulopathy should be spared from undergoing ES in the acute phase.

 
  • References

  • 1 Sawas T, Al Halabi S, Parsi MA. et al. Self-expandable metal stents versus plastic stents for malignant biliary obstruction: a meta-analysis. Gastrointest Endosc 2015; 82: 256-267.e7
  • 2 Lai EC, Tam PC, Paterson IA. et al. Emergency surgery for severe acute cholangitis. The high-risk patients. Ann Surg 1990; 211: 55-59
  • 3 Lai EC, Mok FP, Tan ES. et al. Endoscopic biliary drainage for severe acute cholangitis. NEJM 1992; 326: 1582-1586
  • 4 Kawai K, Akasaka Y, Murakami K. et al. Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc 1974; 20: 148-151
  • 5 Weber A, Roesch T, Pointner S. et al. Transpancreatic precut sphincterotomy for cannulation of inaccessible common bile duct: a safe and successful technique. Pancreas 2008; 36: 187-191
  • 6 Freeman ML, Nelson DB, Sherman S. et al. Complications of endoscopic biliary sphincterotomy. NEJM 1996; 335: 909-918
  • 7 Wada K, Takada T, Kawarada Y. et al. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14: 52-58
  • 8 Sugiyama M, Atomi Y. The benefits of endoscopic nasobiliary drainage without sphincterotomy for acute cholangitis. Am J Gastroenterol 1998; 93: 2065-2068
  • 9 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009; 62: e1-34
  • 10 Hui CK, Lai KC, Yuen MF. et al. Does the addition of endoscopic sphincterotomy to stent insertion improve drainage of the bile duct in acute suppurative cholangitis?. Gastrointest Endosc 2003; 58: 500-504
  • 11 Zhang RL, Zhao H, Dai YM. et al. Endoscopic nasobiliary drainage with sphincterotomy in acute obstructive cholangitis: a prospective randomized controlled trial. J Dig Dis 2014; 15: 78-84
  • 12 Park SY, Park CH, Cho SB. et al. The safety and effectiveness of endoscopic biliary decompression by plastic stent placement in acute suppurative cholangitis compared with nasobiliary drainage. Gastrointest Endosc 2008; 68: 1076-1080
  • 13 Leung JW, Chung SC, Sung JJ. et al. Urgent endoscopic drainage for acute suppurative cholangitis. Lancet 1989; 1: 1307-1309
  • 14 Lee JG. Diagnosis and management of acute cholangitis. Nat Rev Gastroenterol Hepatol 2009; 6: 533-541
  • 15 Boender J, Nix GA, de Ridder MA. et al. Endoscopic sphincterotomy and biliary drainage in patients with cholangitis due to common bile duct stones. Am J Gastroenterol 1995; 90: 233-238
  • 16 Committee ASoP. Maple JT, Ben-Menachem T. et al. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc 2010; 71: 1-9
  • 17 Kiil J, Kruse A, Rokkjaer M. Large bile duct stones treated by endoscopic biliary drainage. Surgery 1989; 105: 51-56
  • 18 Sharma BC, Kumar R, Agarwal N. et al. Endoscopic biliary drainage by nasobiliary drain or by stent placement in patients with acute cholangitis. Endoscopy 2005; 37: 439-443
  • 19 Cui PJ, Yao J, Zhao YJ. et al. Biliary stenting with or without sphincterotomy for malignant biliary obstruction: a meta-analysis. World J Gastroenterol 2014; 20: 14033-14039