{"title":"Sphincterotomy vs Sham Procedure for Pain Relief in Sphincter of Oddi Dysfunction: Systematic Review and Meta-analysis","authors":"Dennis Wang, Kayla Dadgar, Mohammad Yaghoobi","doi":"10.1016/j.tige.2023.10.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and Aims</h3><p><span><span>Endoscopic sphincterotomy (ES) used to be part of </span>sphincter of Oddi dysfunction (SOD) management, but recent studies changed attitudes about its utility. We conducted a </span>systematic review and meta-analysis of randomized sham-controlled trials (RCTs) investigating ES for biliary SOD-related pain.</p></div><div><h3>Methods</h3><p>Articles were retrieved from PubMed, Medline, Embase, and CENTRAL. We included RCTs comparing ES with a sham procedure<span> on post-cholecystectomy patients ≥18 years old with biliary SOD. Standardized data collection sheets were used, as well as the Risk of Bias 2 tool. A random-effects model was used to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Subgroups included normal vs abnormal sphincter of Oddi manometry (SOM) and type II vs III SOD.</span></p></div><div><h3>Results</h3><p>From 517 articles retrieved, 4 RCTs were included, encompassing 376 patients. Overall, no difference existed between ES and the sham procedure in improving biliary SOD-related pain overall (RR 1.32, 95% CI 0.77-2.26, <em>P</em> = .31) and for the normal (RR 0.83, 95% CI 0.42-1.65, <em>P</em> = .60) and abnormal SOM subgroups (RR 1.90, 95% CI 0.84-4.29, <em>P</em><span> = .12). ES was numerically favored over the sham procedure in patients with type II (RR 2.51, 95% CI 1.32-4.81, </span><em>P</em> = .005) but not type III SOD (RR 1.02, 95% CI 0.32-3.27, <em>P</em> = .98). However, there was no significant subgroup difference between these type-based subgroups (<em>P</em> = .18, I<sup>2</sup> = 43.2%).</p></div><div><h3>Conclusion</h3><p>ES does not improve biliary SOD-related pain overall or for type II vs III SOD or normal vs abnormal SOM subgroups. This meta-analysis confirms that there is no proven role for SOM or ES in managing SOD.</p></div>","PeriodicalId":1,"journal":{"name":"Accounts of Chemical Research","volume":null,"pages":null},"PeriodicalIF":16.4000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Accounts of Chemical Research","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2590030723000740","RegionNum":1,"RegionCategory":"化学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CHEMISTRY, MULTIDISCIPLINARY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and Aims
Endoscopic sphincterotomy (ES) used to be part of sphincter of Oddi dysfunction (SOD) management, but recent studies changed attitudes about its utility. We conducted a systematic review and meta-analysis of randomized sham-controlled trials (RCTs) investigating ES for biliary SOD-related pain.
Methods
Articles were retrieved from PubMed, Medline, Embase, and CENTRAL. We included RCTs comparing ES with a sham procedure on post-cholecystectomy patients ≥18 years old with biliary SOD. Standardized data collection sheets were used, as well as the Risk of Bias 2 tool. A random-effects model was used to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Subgroups included normal vs abnormal sphincter of Oddi manometry (SOM) and type II vs III SOD.
Results
From 517 articles retrieved, 4 RCTs were included, encompassing 376 patients. Overall, no difference existed between ES and the sham procedure in improving biliary SOD-related pain overall (RR 1.32, 95% CI 0.77-2.26, P = .31) and for the normal (RR 0.83, 95% CI 0.42-1.65, P = .60) and abnormal SOM subgroups (RR 1.90, 95% CI 0.84-4.29, P = .12). ES was numerically favored over the sham procedure in patients with type II (RR 2.51, 95% CI 1.32-4.81, P = .005) but not type III SOD (RR 1.02, 95% CI 0.32-3.27, P = .98). However, there was no significant subgroup difference between these type-based subgroups (P = .18, I2 = 43.2%).
Conclusion
ES does not improve biliary SOD-related pain overall or for type II vs III SOD or normal vs abnormal SOM subgroups. This meta-analysis confirms that there is no proven role for SOM or ES in managing SOD.
期刊介绍：
Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance.
Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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