Summary of findings for the main comparison. Open surgery compared to ERCP for bile duct stones.
| Open surgery compared to ERCP for bile duct stones | ||||||
| Patient or population: with common bile duct stones Settings: secondary or tertiary hospital Intervention: open surgery Comparison: ERCP + LC | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| ERCP + LC | Open surgery | |||||
| Mortality | Study population | 0.51 (0.18 to 1.44) | 733 (8 studies) | ⊕⊕⊕⊝ moderate1,2 | ||
| 3 per 100 | 1 per 100 (0 to 4) | |||||
| Moderate | ||||||
| 2 per 100 | 1 per 100 (0 to 3) | |||||
| Total morbidity | Study population | OR 1.12 (0.77 to 1.62) | 729 (8 studies) | ⊕⊕⊕⊝ moderate1 | ||
| 19 per 100 | 21 per 100 (15 to 27) | |||||
| Moderate | ||||||
| 17 per 100 | 19 per 100 (14 to 25) | |||||
| Failure of procedure | Study population | OR 0.32 (0.21 to 0.48) | 943 (7 studies) | ⊕⊕⊕⊝ moderate1,2 | ||
| 200 per 1000 | 74 per 1000 (50 to 107) | |||||
| Moderate | ||||||
| 188 per 1000 | 69 per 1000 (46 to 100) | |||||
| Retained stones after primary intervention | Study population | OR 0.36 (0.23 to 0.57) | 943 (7 studies) | ⊕⊕⊕⊝ moderate3 | ||
| 144 per 1000 | 57 per 1000 (37 to 87) | |||||
| Moderate | ||||||
| 165 per 1000 | 66 per 1000 (43 to 101) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds ratio; | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 High‐risk surgical participants are included in one trial. 2Bornman 1992 is not a published trial and therefore could not be included in all the outcome analysis. 3 Randomisation of the studies was performed on confirmation of ductal stones and on suspicion of ductal stones in these studies.