Aims To investigate the role of
endoscopic sphincterotomy (ES) with endoscopic biliary drainage (EBD) in acute severe obstructive
cholangitis management by performing a meta-analysis of controlled trials. Method We searched PubMed and Embase for controlled studies that compared endoscopic drainage with ES versus Non-ES in acute obstructive
cholangitis. Two reviewers selected the studies and extracted the data. Disagreement was addressed by a third reviewer. Heterogeneity of the studies was analyzed by Cochran's Q statistics. A Mantel-Haenszel risk ratio was calculated utilizing a random effects model. Results Four controlled studies met our inclusion criteria with 392 participants (201 ES, 191 Non-ES). The outcomes were drainage insertion success rate, drainage effectiveness, post drainage
pancreatitis,
bleeding, procedure duration, perforation,
cholecystitis, and 30-day mortality. Drainage insertion success rate was identical in both groups (RR: 1.00, 95 %CI% 0.96 - 1.04). Effective drainage was not significantly different (RR: 1.11, 95 %CI 0.73 - 1.7). There was no significant difference in the incidence of
pancreatitis post EBD between the ES and Non-ES groups at 3 % and 4 %, respectively (RR: 0.73, 95 %CI 0.24 - 2.27). However, there was a significant increase in post EBD
bleeding with ES compared to Non-ES (RR: 8.58, 95 %CI 2.03 - 36.34). Thirty-day mortality was similar between ES and Non-ES groups at 0.7 % and 1 %, respectively (RR: 0.5, 95 %CI 0.05 - 5.28). Conclusion Our findings show that EBD without ES is an effective drainage technique and carries less risk for post procedure
bleeding. Patients who are
critically ill and have coagulopathy should be spared from undergoing ES in the acute phase.