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Endocut Versus Conventional Blended Electrosurgical Current for Endoscopic Biliary Sphincterotomy: A Meta-Analysis of Complications

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Abstract

Background and Aims

Endoscopic biliary sphincterotomy (EST) is commonly performed during therapeutic endoscopic retrograde cholangiopancreatography (ERCP), but is an independent risk factor for post-ERCP pancreatitis, bleeding and duodenal perforation. These are partly ascribed to the electrosurgical current mode used for EST, and currently the optimal current model for EST remains controversial. In this study, we aimed to compare the rate of complications undergoing EST using the Endocut versus the blended current.

Methods

A systematic search of databases was performed for relevant published and prospective studies including randomized clinical trials (RCTs) to compare Endocut with blended current modes for EST. Data were collected from inception until 1 July 2018, using post-ERCP pancreatitis, bleeding and perforation as primary outcomes.

Results

Three RCTs including a total of 594 patients met the inclusion criteria. Our meta-analysis results showed the rate of post-ERCP pancreatitis, primarily mild to moderate pancreatitis, was no different between Endocut versus blended current modes [risk ratio (RR) 0.61, 95% confidence interval (CI) 0.25–1.52, P = 0.29]. However, the risk of endoscopically bleeding events, primarily mild bleeding, was lower in studies using Endocut versus blended current (RR 0.54, 95% CI 0.31–0.95, P = 0.03). Notably, none of the patients experienced perforation in these three trials.

Conclusions

The rate of post-ERCP pancreatitis was not significantly different when using the Endocut versus blended current during EST. Nevertheless, compared with the blended current, Endocut reduced the incidence of endoscopically evident bleeding; however, the available data were insufficient to assess the perforation risk.

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Abbreviations

EST:

Endoscopic biliary sphincterotomy

ERCP:

Endoscopic retrograde cholangiopancreatography

RR:

Risk ratio

CI:

Confidence interval

RCTs:

Randomized clinical trials

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Acknowledgments

This work was supported by the Natural Science Foundation of Hunan Province (no. 2017JJ3270), Natural Science Foundation of Guangdong Province (no. 2018A0303100024), Three Engineering Training Funds in Shenzhen (nos. SYLY201718 and SYLY201801) Technical Research and Development Project of Shenzhen (no. JCYJ20150403101028164), National Key R&D Program of China (nos. 2017YFC1308800 and 2018YFC1313103) and National Natural Science Foundation of China (nos. 81670473 and 81873546).

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Author notes

  1. De-feng Li, Mei-feng Yang, Xin Chang, Nan-nan Wang, Fang-fang Tan and Hai-na Xie contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Gastroenterology, The 2nd Clinical Medicine College (Shenzhen People’s Hospital) of Jinan University, Shenzhen, 518020, China

    De-feng Li, Jian-yao Wang, Zhi-chao Yu, Cheng Wei, Feng Xiong, Ting-ting Liu, Ming-han Luo, Li-sheng Wang & Jun Yao

  2. Integrated Chinese and Western Medicine Postdoctoral Research Station, Jinan University, Guangzhou, 510632, China

    De-feng Li

  3. Department of Hematology, The First Affiliated Hospital of University of South China, University of South China, Hengyang, 421001, China

    Mei-feng Yang

  4. Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Yangpu District, Shanghai, 200433, China

    Xin Chang, Xue Fang, Shu-ling Wang, Zhao-shen Li & Yu Bai

  5. Department of Gastroenterology, The First Affiliated Hospital of University of South China, University of South China, Hengyang, 421001, China

    De-feng Li, Nan-nan Wang, Fang-fang Tan & Hai-na Xie

  6. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Wei Fan

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  1. De-feng Li
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Contributions

LW, ZL, YY, YB were responsible for design of the study and reviewed the manuscript. DL, MY, XC, XF, SW drafted the manuscript. NW, FT, HX, JW, SW, ZY, CW, FX, TL, ML were responsible for screening the literature. DL, MY, XC, NW, FT, HX abstracted data and did statistical analysis. WF was responsible for revising the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Yu Bai.

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Li-sheng Wang, Zhao-shen Li, Jun Yao and Yu Bai share co-corresponding authorship.

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Li, Df., Yang, Mf., Chang, X. et al. Endocut Versus Conventional Blended Electrosurgical Current for Endoscopic Biliary Sphincterotomy: A Meta-Analysis of Complications. Dig Dis Sci 64, 2088–2094 (2019). https://doi.org/10.1007/s10620-019-05513-w

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