Giuliana Fulco Gonçalvez, Louise Lopes Barros, Sofia Emereciano Gurgel, Kleyton Santos de Medeiros, Irami Araújo Filho
{"title":"急性胆囊炎的适当时机ERCP和胆囊切除术：系统回顾和荟萃分析。","authors":"Giuliana Fulco Gonçalvez, Louise Lopes Barros, Sofia Emereciano Gurgel, Kleyton Santos de Medeiros, Irami Araújo Filho","doi":"10.1590/acb401025","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To determine if endoscopic retrograde cholangiopancreatography (ERCP) should be performed with surgery or as a different step, on acute cholecystitis, and which strategy has the least complications and morbimortality.</p><p><strong>Methods: </strong>Various databases (PubMed, Embase, Scopus, Web of Science, Science Direct, Cochrane Central Register of Controlled Trials, CINAHL, Latin American and Caribbean Health Sciences Literature, clinical trials, Google Scholar) were searched for randomized trials comparing the different timings for ERCP and cholecystectomy. No language or time restrictions were applied. Risk of bias was assessed with RoB 2.0 (Cochrane's Risk of Bias 2), and evidence certainty evaluated using Grading of Recommendations Assessment, Development and Evaluation. Data synthesis used R-4.1.0 Project for Statistical Computing for Windows, with meta-analysis via fixed-effects model and I2 for heterogeneity.</p><p><strong>Results: </strong>Eleven studies was used, and meta-analysis was performed independently for each outcome. Different outcomes were evaluated, with preoperative ERCP as an intervention and intraoperative ERCP as the control: length of stays (four trials with mean differences - MD = -1.44; 95% confidence interval - 95%CI -3,87-0,98); bile leak (odds ratio - OR = 0.67; 95%CI 0.11-4.09); cholangitis (OR = 1.32; 95%CI 0.29-5.98); bleeding from sphincterotomy (OR = 0.98; 95%CI 0.20-4.86); wound infection (OR = 0.33; 95%CI 0.04-3.14); incisional bleeding (OR = 0.5; 95%CI 0.04-5.70); elevated amylase activity (OR = 5.22; 95%CI 2.17-12.59); acute pancreatitis (OR = 4.61; 95%CI 1.72-12.38); operative time (MD = -6,26; 95%CI -37.24-24.73); failure rate (OR = 1.74; 95%CI 0.99-3.05); conversion (OR = 1.34; 95%CI 0.6-2.96); morbidity (OR = 2.75; 95%CI 1.7-4.47).</p><p><strong>Conclusions: </strong>Risk of bias was significant due to lack of blindness. The morbidity, pancreatitis, and elevated amylase activity outcomes were the only ones to find statistical significance and favored the intraoperative approach.</p>","PeriodicalId":93850,"journal":{"name":"Acta cirurgica brasileira","volume":"40 ","pages":"e401025"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729098/pdf/","citationCount":"0","resultStr":"{\"title\":\"Proper timing or ERCP and cholecystectomy on acute cholecystitis: a systematic review and meta-analysis.\",\"authors\":\"Giuliana Fulco Gonçalvez, Louise Lopes Barros, Sofia Emereciano Gurgel, Kleyton Santos de Medeiros, Irami Araújo Filho\",\"doi\":\"10.1590/acb401025\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To determine if endoscopic retrograde cholangiopancreatography (ERCP) should be performed with surgery or as a different step, on acute cholecystitis, and which strategy has the least complications and morbimortality.</p><p><strong>Methods: </strong>Various databases (PubMed, Embase, Scopus, Web of Science, Science Direct, Cochrane Central Register of Controlled Trials, CINAHL, Latin American and Caribbean Health Sciences Literature, clinical trials, Google Scholar) were searched for randomized trials comparing the different timings for ERCP and cholecystectomy. No language or time restrictions were applied. Risk of bias was assessed with RoB 2.0 (Cochrane's Risk of Bias 2), and evidence certainty evaluated using Grading of Recommendations Assessment, Development and Evaluation. Data synthesis used R-4.1.0 Project for Statistical Computing for Windows, with meta-analysis via fixed-effects model and I2 for heterogeneity.</p><p><strong>Results: </strong>Eleven studies was used, and meta-analysis was performed independently for each outcome. Different outcomes were evaluated, with preoperative ERCP as an intervention and intraoperative ERCP as the control: length of stays (four trials with mean differences - MD = -1.44; 95% confidence interval - 95%CI -3,87-0,98); bile leak (odds ratio - OR = 0.67; 95%CI 0.11-4.09); cholangitis (OR = 1.32; 95%CI 0.29-5.98); bleeding from sphincterotomy (OR = 0.98; 95%CI 0.20-4.86); wound infection (OR = 0.33; 95%CI 0.04-3.14); incisional bleeding (OR = 0.5; 95%CI 0.04-5.70); elevated amylase activity (OR = 5.22; 95%CI 2.17-12.59); acute pancreatitis (OR = 4.61; 95%CI 1.72-12.38); operative time (MD = -6,26; 95%CI -37.24-24.73); failure rate (OR = 1.74; 95%CI 0.99-3.05); conversion (OR = 1.34; 95%CI 0.6-2.96); morbidity (OR = 2.75; 95%CI 1.7-4.47).</p><p><strong>Conclusions: </strong>Risk of bias was significant due to lack of blindness. The morbidity, pancreatitis, and elevated amylase activity outcomes were the only ones to find statistical significance and favored the intraoperative approach.</p>\",\"PeriodicalId\":93850,\"journal\":{\"name\":\"Acta cirurgica brasileira\",\"volume\":\"40 \",\"pages\":\"e401025\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-01-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729098/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Acta cirurgica brasileira\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1590/acb401025\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta cirurgica brasileira","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1590/acb401025","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的：确定急性胆囊炎的内镜逆行胆管造影（ERCP）是否应与手术一起进行，以及哪种策略并发症和死亡率最低。方法：检索各种数据库（PubMed、Embase、Scopus、Web of Science、Science Direct、Cochrane Central Register of Controlled Trials、CINAHL、Latin American and Caribbean Health Sciences Literature、临床试验、谷歌Scholar），检索比较ERCP和胆囊切除术不同时机的随机试验。没有语言或时间限制。采用RoB 2.0 （Cochrane’s Risk of bias 2）评估偏倚风险，采用分级推荐评估、发展和评价评估评估证据确定性。数据综合采用R-4.1.0 Project for Statistical Computing for Windows， meta分析采用固定效应模型，异质性采用I2。结果：使用了11项研究，并对每个结果进行了独立的meta分析。评估不同的结果，术前ERCP作为干预，术中ERCP作为对照：住院时间(4项试验，平均差异- MD = -1.44；95%置信区间- 95% ci -3,87-0,98)；胆漏(优势比- OR = 0.67；95%可信区间0.11 - -4.09);胆管炎(OR = 1.32；95%可信区间0.29 - -5.98);括约肌切开术出血(OR = 0.98；95%可信区间0.20 - -4.86);伤口感染(OR = 0.33；95%可信区间0.04 - -3.14);切口出血(OR = 0.5；95%可信区间0.04 - -5.70);淀粉酶活性升高(OR = 5.22；95%可信区间2.17 - -12.59);急性胰腺炎(OR = 4.61；95%可信区间1.72 - -12.38);手术时间(MD = -6,26；95%可信区间-37.24 - -24.73);故障率(OR = 1.74；95%可信区间0.99 - -3.05);换算(OR = 1.34；95%可信区间0.6 - -2.96);发病率(OR = 2.75；95%可信区间1.7 - -4.47)。结论：由于缺乏盲性，偏倚风险显著。发病率、胰腺炎和淀粉酶活性升高是唯一具有统计学意义的结果，支持术中方法。
Proper timing or ERCP and cholecystectomy on acute cholecystitis: a systematic review and meta-analysis.
Purpose: To determine if endoscopic retrograde cholangiopancreatography (ERCP) should be performed with surgery or as a different step, on acute cholecystitis, and which strategy has the least complications and morbimortality.
Methods: Various databases (PubMed, Embase, Scopus, Web of Science, Science Direct, Cochrane Central Register of Controlled Trials, CINAHL, Latin American and Caribbean Health Sciences Literature, clinical trials, Google Scholar) were searched for randomized trials comparing the different timings for ERCP and cholecystectomy. No language or time restrictions were applied. Risk of bias was assessed with RoB 2.0 (Cochrane's Risk of Bias 2), and evidence certainty evaluated using Grading of Recommendations Assessment, Development and Evaluation. Data synthesis used R-4.1.0 Project for Statistical Computing for Windows, with meta-analysis via fixed-effects model and I2 for heterogeneity.
Results: Eleven studies was used, and meta-analysis was performed independently for each outcome. Different outcomes were evaluated, with preoperative ERCP as an intervention and intraoperative ERCP as the control: length of stays (four trials with mean differences - MD = -1.44; 95% confidence interval - 95%CI -3,87-0,98); bile leak (odds ratio - OR = 0.67; 95%CI 0.11-4.09); cholangitis (OR = 1.32; 95%CI 0.29-5.98); bleeding from sphincterotomy (OR = 0.98; 95%CI 0.20-4.86); wound infection (OR = 0.33; 95%CI 0.04-3.14); incisional bleeding (OR = 0.5; 95%CI 0.04-5.70); elevated amylase activity (OR = 5.22; 95%CI 2.17-12.59); acute pancreatitis (OR = 4.61; 95%CI 1.72-12.38); operative time (MD = -6,26; 95%CI -37.24-24.73); failure rate (OR = 1.74; 95%CI 0.99-3.05); conversion (OR = 1.34; 95%CI 0.6-2.96); morbidity (OR = 2.75; 95%CI 1.7-4.47).
Conclusions: Risk of bias was significant due to lack of blindness. The morbidity, pancreatitis, and elevated amylase activity outcomes were the only ones to find statistical significance and favored the intraoperative approach.
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