Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
Instituto de Ensino, Pesquisa e Inovação. Liga Contra o Câncer, Natal, RN, Brazil.
Medicine (Baltimore). 2022 Sep 30;101(39):e30772. doi: 10.1097/MD.0000000000030772.
Cholecystectomy is the intervention of choice for treating acute cholecystitis; when conservative management does not work, it operates on the patient outside the critical condition. It can be performed together with or after endoscopic papillotomy through endoscopic retrograde cholangiopancreatography (ERCP) when it is concurrent with a situation of cholechodocolithiasis or when there is compression and consequent increase in pressure in the bile duct caused by a calculus jammed in the vesicular infundibulum (Mirizzi's syndrome), with or without jaundice, fever, and pain in the right hypochondrium (Charcot's Triad), which can progress to sepsis of biliary origin. This review aims to assess whether the timing of cholecystectomy (before or after ERCP) interferes with the postoperative period and clinical outcome in patients with acute cholecystitis.
By searching the MEDLINE/PubMed, Embase, Web of Science, ScienceDirect, ClinicalTrials.gov, CINAHAL, Latin American and Caribbean Literature in Health Sciences, Scopus and Cochrane Central databases, Controlled Trials Registry Randomized clinical trials will be searched to analyze whether ERCP performed before or after open or laparoscopic cholecystectomy (LC) in patients with acute cholecystitis is beneficial or not, through the analysis of postoperative complications. No language or publication period restrictions will be imposed. The primary outcome will be postoperative complications (postoperative morbidity and mortality). Four independent reviewers will select the studies and extract data from the original publications, with a fifth reviewer in case of disagreement regarding the inclusion or not of particular research in the present review. The risk of bias will be assessed using The Risk of Bias 2 (RoB 2.0) tool, and the certainty of evidence will be evaluated using the grading of recommendations assessment, development, and evaluation. Data synthesis will be performed using the Review Manager software (RevMan V.5.2.3). To assess heterogeneity, we will calculate the I2 statistics. Additionally, a quantitative synthesis will be performed if the included studies are sufficiently homogeneous.
Since the present study will review secondary data, previously published and scientifically validated, it will not be necessary to obtain ethical approval. The results of this systematic review will be published in a peer-reviewed journal.
International Prospective Registry of Systematic Reviews (PROSPERO) CRD42021290726.
胆囊切除术是治疗急性胆囊炎的首选干预措施；当保守治疗无效时，在患者非危急情况下进行手术。当并发胆石性胆管炎或由于胆囊壶腹内的结石嵌顿导致胆管受压并随之增加压力（Mirizzi 综合征），或出现黄疸、发热和右上腹疼痛（Charcot 三联征）时，可以通过内镜逆行胰胆管造影（ERCP）联合进行，或在 ERCP 后进行胆囊切除术。本综述旨在评估急性胆囊炎患者行胆囊切除术（ERCP 前或 ERCP 后）时机是否会影响术后期间和临床结局。
通过检索 MEDLINE/PubMed、Embase、Web of Science、ScienceDirect、ClinicalTrials.gov、CINAHAL、拉丁美洲和加勒比健康科学文献数据库、Scopus 和 Cochrane 中心数据库，将检索随机对照临床试验，以分析急性胆囊炎患者行 ERCP 前或后行开腹或腹腔镜胆囊切除术（LC）是否有益，通过分析术后并发症来进行分析。不会对语言或出版时间施加限制。主要结局为术后并发症（术后发病率和死亡率）。四位独立评审员将从原始出版物中选择研究并提取数据，如果对特定研究是否包含在本综述中有分歧，将由第五位评审员进行评估。使用风险偏倚 2（RoB 2.0）工具评估偏倚风险，并使用推荐评估、制定和评价分级评估证据确定性。使用 Review Manager 软件（RevMan V.5.2.3）进行数据综合。为了评估异质性，我们将计算 I2 统计量。如果纳入的研究足够同质，还将进行定量综合。
由于本研究将回顾先前发表并经过科学验证的二次数据，因此无需获得伦理批准。本系统评价的结果将发表在同行评议的期刊上。
PROSPERO 注册号：国际前瞻性系统评价注册库（PROSPERO）CRD42021290726。
