Meta-Analysis
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. May 26, 2014; 2(2): 42-48
Published online May 26, 2014. doi: 10.13105/wjma.v2.i2.42
Treatment strategy for gallstone pancreatitis and the timing of cholecystectomy
Chao Hu, Shi-Qiang Shen, Zu-Bing Chen
Chao Hu, Shi-Qiang Shen, Zu-Bing Chen, Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
Author contributions: Hu C conceived and designed the review, conducted the statistical analyses and drafted the manuscript; Shen SQ critically revised the manuscript, and approved the final version of the manuscript submitted for publication; Chen ZB identified and acquired reports of trials and analyzed the data.
Correspondence to: Shi-Qiang Shen, MD, Department of General Surgery, Renmin Hospital of Wuhan University, Ziyang Road 99 #, Wuhan 430060, Hubei Province, China. swsw2218@hotmail.com
Telephone: +86-27-88041911  Fax: +86-27-88042292
Received: November 23, 2013
Revised: January 18, 2014
Accepted: March 3, 2014
Published online: May 26, 2014
Processing time: 208 Days and 22.5 Hours
Abstract

AIM: To reviewed the literature and evaluated the scope and timing of the application of endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (ES) and cholecystectomy.

METHODS: A pooled odds ratio (OR) and a pooled mean difference with the 95%CI were used to assess the enumeration data of included studies. A pooled weighted mean difference (WMD) and a pooled mean difference with the 95%CI were used to assess the measurement data of included studies. Statistical heterogeneity was tested with the χ2 test. According to forest plots, heterogeneity was not significant, so the fixed effect model was adopted. The significance of the pooled OR was determined by the Z test and statistical significance was considered at P < 0.05.

RESULTS: Data were collected from two studies (353 patients, 142 in the early cholecystectomy group and 211 in the delayed cholecystectomy group) regarding the length of hospital stay [The WMD was -2.87 (95%CI: -3.36--2.39, P < 0.01). Data were collected from four studies (618 patients, 211 in the early cholecystectomy group and 408 in the delayed cholecystectomy group) regarding perioperative complications (OR = 0.94, 95%CI: 0.41-2.12, P > 0.05). Data were collected from four studies (618 patients, 211 in the early cholecystectomy group and 408 in the delayed cholecystectomy group) on the number of patients who underwent ERCP± ES postoperatively (OR = 0.80, 95%CI: 0.45-1.41, P > 0.05).

CONCLUSION: Cholecystectomy offers better protection than ES against further bouts of pancreatitis in patients with gallstone pancreatitis, although ES is an acceptable alternative.

Keywords: Gallstone pancreatitis, Endoscopic retrograde cholangiopancreatography, Endoscopic sphincterotomy, Cholecystectomy

Core tip: In this study we reviewed the literature and evaluated the scope and timing of the application of endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (ES) and cholecystectomy. We also carried out a meta-analysis regarding the timing of cholecystectomy and found that early cholecystectomy administered to patients with mild gallstone pancreatitis could reduce the length of hospital stay with no increase in perioperative complications or the incidence of postoperative ERCP ± ES.