The safety of not implementing endoscopic nasobiliary drainage after elective clearance of choledocholithiasis: a systematic review and meta-analysis

• Published in: BMC surgery 2024-08, Vol.24 (1), p.239-9
• Main Authors: Yin, Jie, Wang, Dongying, He, Yujing, Sha, Hongcun, Zhang, Wenhao, Huang, Wei
• Format: Article
• Language: English
• Subjects: Analysis; Bias; Bile ducts; Bilirubin; Cholangitis; Choledocholithiasis; Choledocholithiasis - surgery; Clinical trials; Cohort analysis; Complications; Complications and side effects; Drainage - methods; Elective Surgical Procedures - methods; Endoscopic nasobiliary drainage; Endoscopic retrograde cholangiopancreatography; Endoscopy; Gallstones; Humans; Laparoscopic common bile duct exploration; Meta-analysis; Pancreatitis; Patients; Postoperative; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Randomized Controlled Trials as Topic; Safety and security measures; Statistical analysis; Statistical methods; Subgroups; Surgery; Surgical drains; Wound drainage
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-024-02535-8

Endoscopic nasobiliary drainage (ENBD) is used as a drainage technique in patients with choledocholithiasis after stone removal. However, ENBD can cause discomfort, displacement, and other complications. This study aims to evaluate the safety of not using ENBD following elective clearance of choledocholithiasis. Relevant studies were identified by searching PubMed, Web of Science, EMBASE, EBSCO, and Cochrane Library from their inception until August 2023. The main outcomes assessed were postoperative complications and postoperative outcomes. Subgroup analyses were conducted based on study design types and treatment procedures. Six studies, including three randomized controlled trials (RCTs) and three cohort studies, were analyzed. Among these, four studies utilized endoscopic techniques, and two employed surgical methods for choledocholithiasis clearance. The statistical analysis showed no significant difference in postoperative complications between the no-ENBD and ENBD groups, including pancreatitis (RR: 1.55, p = 0.36), cholangitis (RR: 1.81, p = 0.09), and overall complications (RR: 1.25, p = 0.38). Regarding postoperative outcomes, the subgroup analysis indicated that the bilirubin normalization time was longer in the no-ENBD group compared to the ENBD group in RCTs (WMD: 0.24, p = 0.07) and endoscopy studies (WMD: 0.23, p = 0.005), although the former did not reach statistical difference. There was also no significant difference in the length of postoperative hospital stay between the groups (WMD: -0.30, p = 0.60). It appears safe to no- ENBD after elective clearance of choledocholithiasis.