Meta-analysis of stapled hemorrhoidopexy vs LigaSure hemorrhoidectomy

AIM: To compare outcome of stapled hemorrhoidopexy (SH) vs LigaSure hemorrhoidectomy (LH) by a meta-analysis of available randomized controlled trials (RCTs). METHODS: Databases, including PubMed, EMBASE, the Cochrane Library, and the Science Citation Index updated to December 2012, were searched. The main outcomes measured were operating time, early postoperative pain, postoperative urinary retention and bleeding, wound problems, gas or fecal incontinence, anal stenosis, length of hospital stay, residual skin tags, prolapse, and recurrence. The meta-analysis was performed using the free software Review Manager. Differences observed between the two groups were expressed as the odds ratio (OR) with 95%CI. A fixedeffects model was used to pool data when statistical heterogeneity was not present. If statistical heterogeneity was present (P < 0.05), a random-effects model was used. RESULTS: The initial search identified 10 publica-tions. After screening, five RCTs published as full articles were included in this meta-analysis. Among the five studies, all described a comparison of the patient baseline characteristics and showed that there was no statistically significant difference between the two groups. Although most of the analyzed outcomes were similar between the two operative techniques, the operating time for SH was significantly longer than for LH (P < 0.00001; OR= -6.39, 95%CI: -7.68 -5.10). The incidence of residual skin tags and prolapse was significantly lower in the LH group than in the SH group [2/111 (1.8%) vs 16/105 (15.2%); P = 0.0004; OR= 0.17, 95%CI: 0.06-0.45). The incidence of recurrence after the procedures was significantly lower in the LH group than in the SH group [2/173 (1.2%) vs 13/174 (7.5%); P = 0.003; OR= 0.21, 95%CI: 0.07-0.59]. CONCLUSION: Both SH and LH are probably equally valuable techniques in modern hemorrhoid surgery. However, LigaSure might have slightly favorable immediate postoperative results and technical advantages.

Biliary stenting with or without sphincterotomy for malignant biliary obstruction:A meta-analysis

AIM:To investigate the benefits of endoscopic sphincterotomy(EST) before stent placement by meta-analysis of randomized controlled trials(RCTs). METHODS:PubMed,EMBASE,Cochrane Library,and Science Citation Index databases up to March 2014 were searched. The primary outcome was incidence of post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) and successful stent insertion rate. The secondary outcomes were the incidence of post-ERCP bleeding,stent migration and occlusion. The free software Review Manager was used to perform the meta-analysis.RESULTS:Three studies(n=338 patients,170 in the EST group and 168 in the non-EST group)were included.All three studies described a comparison of baseline patient characteristics and showed that there were no statistically significant differences between the two groups.Three RCTs,including 338 patients,were included in this meta-analysis.Most of the analyzed outcomes were similar between the groups.Although EST reduced the incidence of PEP,it also led to a higher incidence of post-ERCP bleeding(OR=0.34,95%CI:0.12-0.93,P=0.04;OR=9.70,95%CI:1.21-77.75,P=0.03,respectively).CONCLUSION:EST before stent placement may be useful in reducing the incidence of PEP.However,ESTrelated complications,such as bleeding and perforation,may offset this effect.

Does hyoscine butylbromide really improve polyp detection during colonoscopy? A meta-analysis of randomized controlled trials

AIM:To investigate the benefits of hyoscine butylbromide in polyp detection during colonoscopy by a meta-analysis of available randomized controlled trials(RCTs).METHODS:Databases,including PubMed,EMBASE,the Cochrane Library,and the Science Citation Index up to September 2013,were searched.The primary outcome was polyp detection rate,and the secondary outcome was adenoma detection rate.The metaanalysis was performed using the free software Review Manager.Differences observed between the treated and the control groups were expressed as odds ratio(OR)with a 95%confidence interval(CI).A fixedeffects model was used to pool data when statistical heterogeneity was absent.If statistical heterogeneity was present(P<0.05),a random-effects model was used.RESULTS:The initial search identified nine articles.After screening,five RCTs with a total of 1998 patients were included in this meta-analysis.Of the five studies,all described a comparison of baseline patient characteristics and showed that there was no statistically significant difference between the two groups.Among the 1998 patients,1006 received hyoscine butylbromide and 992 were allocated to the control group,and the polyp detection rate was reported.There were no significant differences between the treated and the control group(OR=1.09,95%CI:0.91-1.31,P=0.33).Four RCTs included 1882 patients,of whom948 received hyoscine butylbromide,and the adenoma detection rate was reported.There were no significant differences between the treated and the control group(OR=1.13,95%CI:0.92-1.38,P=0.24).CONCLUSION:The use of hyoscine butylbromide did not significantly improve the polyp detection rate during colonoscopy.