Supplementary Material for: BILIARY SPHINCTEROTOMY ALONE VS BILIARY STENT WITH OR WITHOUT BILIARY SPHINCTEROTOMY FOR THE MANAGEMENT OF POST-CHOLECYSTECTOMY BILE LEAK: A SYTEMATIC REVIEW AND META-ANALYSIS

BACKGROUND: Endoscopic therapy with ERCP is considered the first line treatment in the management of post-cholecystectomy bile leak (PCBL). Currently there is no consensus on the most effective endoscopic intervention for PCBL. Hence, we performed a systematic review and meta-analysis to compare the effectiveness and safety of the two interventional groups (biliary sphincterotomy [BS] alone vs biliary stent ± BS) in management of PCBL.

METHODS: We conducted a comprehensive search of multiple electronic databases and conference proceedings (from inception through January 2021). The primary outcome was to compare the pooled rate of clinical success between the 2 groups. The secondary outcome was to estimate the pooled rate of adverse events.

RESULTS: The pooled rate of clinical success with BS alone (5 studies, 299 patients) was 88% (95% CI: 84%- 92%, I2: 0%) and for biliary stent ± BS (5 studies, 864 patients) was 97% (CI: 93%-100%, I2: 79%). The rate of clinical success in biliary stent ± BS group was significantly higher than BS alone group (OR: 3.91 95% CI: 2.29-6.69, p<0.001, I2: 13%). The rate of adverse events was numerically lower in biliary stent ± BS group compared to BS alone (3 studies; OR: 0.65 95% CI: 0.41-1.03, p=0.07) without statistical significance. Low heterogeneity was noted in the analysis.

CONCLUSIONS: Biliary stent ± BS is more effective in endoscopic management of PCBL compared to BS alone. This may be related to inter-endoscopist variation in completeness of sphincterotomy and post sphincterotomy edema, which can influence the preferential trans-papillary flow of bile.