BMJ open gastroenterology · 2021
Systematic review and meta-analysis of gallstone disease treatment outcomes in early cholecystectomy versus conservative management/delayed cholecystectomy.
СтатьяМетаанализПоддержка исследования: вне правительства СШАСистематический обзорНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Bagepally Bhavani Shankara, Haridoss Madhumitha, Sasidharan Akhil, Jagadeesh Kayala Venkata, Oswal Nikhil Kumar
Аннотация
BACKGROUND: The effectiveness of early cholecystectomy for gallstone diseases treatment is uncertain compared with conservative management/delayed cholecystectomy.
AIMS: To synthesise treatment outcomes of early cholecystectomy versus conservative management/delayed cholecystectomy in terms of its safety and effectiveness.
DESIGN: We systematically searched randomised control trials investigating the effectiveness of early cholecystectomy compared with conservative management/delayed cholecystectomy. We pooled the risk ratios with a 95% CI, also estimated adjusted number needed to treat to harm.
RESULTS: Of the 40 included studies for systematic review, 39 studies with 4483 patients are included in meta-analysis. Among the risk ratios of gallstone complications, pain (0.38, 0.20 to 0.74), cholangitis (0.52, 0.28 to 0.97) and total biliary complications (0.33, 0.20 to 0.55) are significantly lower with early cholecystectomy. Adjusted number needed to treat to harm of early cholecystectomy compared with conservative management/delayed cholecystectomy are, for pain 12.5 (8.3 to 33.3), biliary pancreatitis >1000 (50-100), common bile duct stones 100 (33.3 to 100), cholangitis (100 (25-100), total biliary complications 5.9 (4.3 to 9.1) and mortality >1000 (100 to100 000).
CONCLUSIONS: Early cholecystectomy may result in fewer biliary complications and a reduction in reported abdominal pain than conservative management.
PROSPERO REGISTRATION NUMBER: 2020 CRD42020192612.
AIMS: To synthesise treatment outcomes of early cholecystectomy versus conservative management/delayed cholecystectomy in terms of its safety and effectiveness.
DESIGN: We systematically searched randomised control trials investigating the effectiveness of early cholecystectomy compared with conservative management/delayed cholecystectomy. We pooled the risk ratios with a 95% CI, also estimated adjusted number needed to treat to harm.
RESULTS: Of the 40 included studies for systematic review, 39 studies with 4483 patients are included in meta-analysis. Among the risk ratios of gallstone complications, pain (0.38, 0.20 to 0.74), cholangitis (0.52, 0.28 to 0.97) and total biliary complications (0.33, 0.20 to 0.55) are significantly lower with early cholecystectomy. Adjusted number needed to treat to harm of early cholecystectomy compared with conservative management/delayed cholecystectomy are, for pain 12.5 (8.3 to 33.3), biliary pancreatitis >1000 (50-100), common bile duct stones 100 (33.3 to 100), cholangitis (100 (25-100), total biliary complications 5.9 (4.3 to 9.1) and mortality >1000 (100 to100 000).
CONCLUSIONS: Early cholecystectomy may result in fewer biliary complications and a reduction in reported abdominal pain than conservative management.
PROSPERO REGISTRATION NUMBER: 2020 CRD42020192612.