Valvano Marco, Balducci Daniele, Vinci Antonio, Ghezzi Andrea, Djahandideh Shirin, Fabiani Stefano, Stefanelli Gianpiero, Buccilli Silvia, Montale Amedeo, Antonini Filippo, Maroni Luca, Campanale Chiara
Department of Health Sciences, University of L'Aquila Department of Health Sciences, L'Aquila, Italy.
S.C. Gastroenterologia, Ente Ospedaliero Ospedali Galliera, Genova, Italy.
Endosc Int Open. 2025 May 12;13:a25866007. doi: 10.1055/a-2586-6007. eCollection 2025.
Laparoscopic cholecystectomy is the standard treatment for patients with cholecystitis or gallbladder stones after common bile duct (CBD) clearance. According to the sequential strategy, cholecystectomy should be performed within 2 weeks after CDB clearance with endoscopic retrograde cholangiopancreatography (ERCP). However, in real-life experience, the average waiting time is 60 to 180 days. We aimed to evaluate the clinical rationale for prophylactic stent placement in CBD to prevent recurrent biliary events.
This systematic review and meta-analysis was performed following a protocol designed a priori (PROSPERO: CRD42024564804; July 13, 2024). All published studies involving patients who had undergone ERCP for CBDs and who were awaiting cholecystectomy were included.
At the end of the revision process, four full texts including 755 patients were included in the meta-analysis. The odds ratio (OR) for symptom recurrence in patients awaiting cholecystectomy was 0.74 (95% confidence interval [CI] 0.30-1.79; I 67%). The pooled OR for adverse event occurrence was 0.74 (95% CI 0.45-1.24) in the stent group. The post-ERCP pancreatitis and cholangitis risk were 0.76 (95% CI 0.25-2.34) and 0.92 (95% CI 0.31-2.67), respectively.
This meta-analysis showed no benefit for stent insertion after bile duct clearance in patients scheduled for delayed cholecystectomy. Further randomized controlled trials with bigger cohorts are needed to assess any benefit for this procedure, which in the meantime, cannot be recommended.
对于经胆总管（CBD）清理后患有胆囊炎或胆囊结石的患者，腹腔镜胆囊切除术是标准治疗方法。根据序贯策略，应在内镜逆行胰胆管造影术（ERCP）清理胆总管后2周内进行胆囊切除术。然而，在实际临床经验中，平均等待时间为60至180天。我们旨在评估在胆总管中预防性放置支架以预防复发性胆道事件的临床依据。
本系统评价和荟萃分析按照预先设计的方案进行（国际前瞻性系统评价注册库：CRD42024564804；2024年7月13日）。纳入所有已发表的涉及接受过胆总管ERCP且等待胆囊切除术患者的研究。
在修订过程结束时，四项全文共755例患者纳入荟萃分析。等待胆囊切除术患者症状复发的比值比（OR）为0.74（95%置信区间[CI]0.30 - 1.79；I² 67%）。支架组不良事件发生的合并OR为0.74（95% CI 0.45 - 1.24）。ERCP后胰腺炎和胆管炎的风险分别为0.76（95% CI 0.25 - 2.34）和0.92（95% CI 0.31 - 2.67）。
这项荟萃分析表明，对于计划进行延迟胆囊切除术的患者，胆总管清理后放置支架并无益处。需要进一步开展更大样本量的随机对照试验来评估该操作的任何益处，在此期间，不推荐使用此方法。
