P1778 - Conservative Management versus Early Cholecystectomy for Gallstone Disease: A Meta-Analysis of Randomized Controlled Trials

Muhammad Ayyan, MBBS¹, Kissan Ghose, BSc², Arooj Waheed, BSc³, Samina Khan, MD⁴, David Losier, BS⁵, Anumalasetty Venkata Chandana Heshma, MD⁶, Avni Bhatia, MBBS⁷, Deepalee Mehta, MBBS⁸, Ayesha Abbas, MD⁹, Iqra Yaseen Khan, MD¹, Ibtesam Allahi, MBBS¹⁰, Ambreen Nabeel, MBBS¹¹, Amna Iqbal, MD¹², Rehmat Ullah Awan, MD^13
1King Edward Medical University, Lahore, Punjab, Pakistan; ²University of Lethbridge, Lethbridge, AB, Canada; ³Humber College, Toronto, ON, Canada; ⁴University of Alberta, Edmonton, AB, Canada; ⁵SUNY Upstate Medical University, Syracuse, NY; ⁶Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinna Avutapalle, Andhra Pradesh, India; ⁷Jawaharlal Nehru Medical College, Belagavi, Karnataka, India; ⁸Bharati Vidyapeeth Medical College, Pune, Maharashtra, India; ⁹Akhtar Saeed Medical and Dental College, Lahore, Punjab, Pakistan; ¹⁰Allama Iqbal Medical College, Lahore, Punjab, Pakistan; ¹¹Ochsner Health Systems, Meridian, MS; ¹²University of Toledo Medical Center, Toledo, OH; ¹³West Virginia University, Morgantown, WV

Introduction: While most individuals with gallstone disease remain asymptomatic, symptoms of gallstone disease range from biliary pain to acute cholecystitis. Surgery is a popular choice of treatment but evidence has also suggested conservative management as a safe and viable approach. We aim to investigate the evidence on conservative management versus early cholecystectomy for the management of gallstone disease.


Methods: We searched electronic databases to retrieve and include all randomized controlled trials (RCTs) that analyzed the efficacy and safety of conservative management versus early cholecystectomy in the management of gallstone disease. The revised Cochrane “Risk of bias" tool for randomized trials (RoB 2.0) was used to assess the risk of bias in the included studies. We calculated risk ratios (RR) along with the 95% confidence intervals (95% CI) for all the outcomes.


Results: A total of eleven RCTs were included in our meta-analysis. We found no statistically significant difference between conservative management and early cholecystectomy regarding the incidence of total intraoperative complications (RR 0.45; 95% CI: 0.14-1.42), total postoperative complications (RR 0.85; 95% CI: 0.48-1.50), total surgical complications (RR 0.68; 95% CI: 0.43-1.10), and mortality (RR 1.24; 95% CI: 0.81-1.89). The conservative management group was associated with a statistically significant higher incidence of total biliary complications (RR 3.63; 95% CI: 2.07-6.37), biliary colic (RR 2.75; 95% CI: 1.23-6.15), and common bile duct (CBD) stones (RR 3.96; 95% CI: 1.46-10.71). There was no difference in the incidence of biliary pancreatitis (RR 1.46; 95% CI: 0.49-4.35) and cholangitis (RR 1.52; 95% CI: 0.47-4.89).




Discussion: According to our meta-analysis, the conservative management offers no benefit over early cholecystectomy for gallstone disease and it increases the incidence of biliary complications in patients with gallstone disease. More studies are needed to better ascertain the role of conservative management in the management of gallstone disease.




Disclosures:


Muhammad Ayyan, MBBS¹, Kissan Ghose, BSc², Arooj Waheed, BSc³, Samina Khan, MD⁴, David Losier, BS⁵, Anumalasetty Venkata Chandana Heshma, MD⁶, Avni Bhatia, MBBS⁷, Deepalee Mehta, MBBS⁸, Ayesha Abbas, MD⁹, Iqra Yaseen Khan, MD¹, Ibtesam Allahi, MBBS¹⁰, Ambreen Nabeel, MBBS¹¹, Amna Iqbal, MD¹², Rehmat Ullah Awan, MD¹³. P1778 - Conservative Management versus Early Cholecystectomy for Gallstone Disease: A Meta-Analysis of Randomized Controlled Trials, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.