Randomized Controlled Trials of the Outcomes of Endoscopic Sphincterotomy (ES), Open Surgical Duct Exploration (Surg.), and Laparoscopic Surgery (Lap.), 1980–2000.
Randomized Controlled Trials of the Outcomes of Endoscopic Sphincterotomy (ES), Open Surgical Duct Exploration (Surg.), and Laparoscopic Surgery (Lap.), 1980–2000.
| Author | Intervention | Mean Age y (range or ±SD) | Patients n | Stone Clearance n (%)* | Additional CBDI needed (ES or Surg.) n (%)† | Minor and Major Complications n (%)† | Mortality n (%) | Length of Hospital Stay d (mean or mean range) | Author Conclusions |
|---|---|---|---|---|---|---|---|---|---|
| Neoptolemos et al. (1987)9 | ES | 61 (20–83) | 55 | 50/55 (91.0) | 2/55 (2.8) | 18/55 (32.7) | 2/55 (3.6) | 9 | No support for ES for CBD stones |
| Surg. | 59 (20–82) | 59 | 54/59 (91.5) | 0/59 (0.0) | 13/59 (22.1) | 1/59 (1.7) | 11 | ||
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| Stain et al. (1991)38 | ES | 48.4 (31–78) | 26 | 17/26 (65.4) | 1/26 (3.1) | 4/26 (15.4) | 0.0 | 5 | No support for ES for CBD stones |
| Surg. | 42.4 (20–86) | 26 | 16/17 (84.2) | 1/17 (3.1) | 8/26 (30.8) | 0.0 | 6 | ||
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| Stiegmann et al. (1992)39 | ES | 46.3±21.7 | 16 | 5/7 (71.4) | 2/7 (28.6) | 0 (0.0) | 0.0 | 11.0 | No advantage to treating CBD stones with ES |
| Surg. | 38.1±14.8 | 18 | 6/7 (85.7) | Not given | 3/18 (16.7) | 0.0 | 9.2 | ||
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| Hammarström et al. (1995)40 | ES | 75.0 (56–85) | 39 | 35/39 (89.7) | 7/39 (17.9) | 7/39 (17.9) | 0.0 | 13‡ | ES and Surg. for CBD stones are equally effective |
| Surg. | 73.5 (56–85) | 41 | 37/41 (90.2) | 6/41 (14.6) | 9/41 (22.0) | 0.0 | 16‡ | ||
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| Kapoor et al. (1996)42 | ES | 42 (20–60) | 13 | 11/13 (85) | 2/13 (15) | 5/13 (38.5) | 0 (0.0) | 10.6 | No support for ES in low-risk patients with CBD |
| Surg. | 46 (24–75) | 16 | 13/15 (87) | 2/15 (13) | 5/16 (31.3) | 0 (0.0) | 11.3 | ||
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| Targarona et al. (1996)41 | ES | 79 | 50 | NG | 2/50 (4.0) | 8/50 (16) | 3/50 (6.0) | 17 | In elderly or high-risk patients, surgery is preferable to ES |
| Surg. | 80 | 48 | NG | 1/48 (2.1) | 11/48 (23) | 2/48 (4.0) | 22 | ||
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| Rhodes et al. (1998)44 | ES | 68 (28–84) | 40 | 37/40 (92.5) | 10/40 (25.0) | 6/40 (15.0) | 0 (0.0) | 3.5‡ | Lap. is as effective as ES in clearing CBD stones |
| Lap. | 62 (24–83) | 40 | 40/40 (100) | 10/40 (25.0) | 7/40 (17.5) | 0 (0.0) | 1‡ | ||
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| Suc et al. (1998)43 | ES | 66.8±17.5 | 97 | 64/80 (80.0) | 28/97 (28.9) | 11/97 (11.3) | 3/97 (3.1) | 15.3 | High risk of added procedures after ES precludes its use for treating CBD stones |
| Surg. | 66.7±18.1 | 105 | 75/81 (92.6) | 8/105 (7.6) | 13/105 (12.3) | 1/105 (1.0) | 17.5 | ||
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| Cuschieri et al. (1999)45 | ES | 18–89 | 136 | 82/98 (83.7) | 16/98 (16.3) | 17/133 (12.8) | 2/136 (1.5) | 9‡ | Similar outcomes for ES and Lap., shorter hospital stay with Lap. ES to be confined to high-risk patients |
| Lap. | 19–88 | 133 | 90/109 (82.6) | 19/109 (17.4) | 21/133 (15.8) | 1/133 (0.8) | 6‡ | ||
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| Total | ES | 472 | 301/358 (84.1) | 70/472 (14.8) | 73/472 (15.5) | 10/472 (2.1) | 3.5–17 | ||
| Surg. | 313 | 201/220 (91.4) | 37/265 (14.0) | 60/313 (19.2) | 4/313 (1.3) | 6–22 | |||
| Lap. | 173 | 130/149 (87.2) | 29/149 (19.5) | 28/173 (16.2) | 1/173 (0.6) | 1–6 | |||