Adverse events after biliary sphincterotomy: Does the electric current mode make a difference? A systematic review and meta-analysis of randomized controlled trials

• Published in: Clinics and research in hepatology and gastroenterology 2020-10, Vol.44 (5), p.739-752
• Main Authors: Funari, Mateus Pereira, Ribeiro, Igor Braga, de Moura, Diogo Turiani Hourneaux, Bernardo, Wanderley Marques, Brunaldi, Vitor Ottoboni, Rezende, Daniel Tavares, Resende, Ricardo Hannum, de Marco, Michele Oliveira, Franzini, Tomazo Antonio Prince, de Moura, Eduardo Guimarães Hourneaux
• Format: Article
• Language: English
• Subjects: Adverse events; Electric current; Endoscopic retrograde cholangiopancreatography; ERCP; Sphincterotomy; Systematic review
• ISSN: 2210-7401; 2210-741X
• DOI: 10.1016/j.clinre.2019.12.009

•Endoscopic retrograde cholangiopancreatography (ERCP) is a widely performed procedure, but it is associated with a significant incidence of complications.•The electric current mode used during endoscopic biliary sphincterotomy has influence in the incidence of adverse events, such as pancreatitis and bleeding.•Using a systematic review and meta-analysis of the best evidence level in the literature (randomized clinical trials) we expose the safety profile of the most used modalities.•There is no perfect electric current mode to be used in every situation; therefore it is essential to understand the mechanism of action of each modality in order to make the best choice in clinical practice. Biliary sphincterotomy is an invasive method that allows access to the bile ducts, however, this procedure is not exempt of complications. Studies in the literature indicate that the mode of electric current used for sphincterotomy may carry different incidences of adverse events such as pancreatitis, hemorrhage, perforation, and cholangitis. To evaluate the safety of different modes of electrical current during biliary sphincterotomy based on incidence of adverse events. We searched articles for this systematic review in Medline, EMBASE, Central Cochrane, Lilacs, and gray literature from inception to September 2019. Data from studies describing different types of electric current were meta-analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following electric current modalities were evaluated: endocut, blend, pure cut, pure cut followed by blend, monopolar, and bipolar. A total of 1791 patients from 11 randomized clinical trials evaluating the following comparisons: 1. Endocut vs Blend: No statistical difference in the incidence of bleeding (7% vs 13.4%; RD: −0.11 [−0.31, 0.08], P=0.27, I2=86%), pancreatitis (4.4% vs 3.5%; RD: 0.01 [−0.03, 0.04], P=0.62, I2=48%) and perforation (absence of cases in both arms). 2. Endocut vs Pure cut: Higher incidence of mild bleeding (without drop in hemoglobin levels, clinical repercussion or need for endoscopic intervention) in the pure cut group (9.2% vs 28.8%; RD: −0.19 [−0.27, −0.12], P