Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is moderate or low to moderate where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes.
Population: Adults with common bile duct stones
Intervention: Laparoscopic cholecystectomy plus laparoscopic common bile duct exploration (LC plus LCBDE)
Comparison: Endoscopic retrograde cholangiopancreatography (ERCP) plus LC
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
LC plus LCBDE versus preoperative ERCP plus LC | ||
Mortality at 30 days | No statistically significant difference | Moderate |
Total morbidity (time point unclear) | No statistically significant difference | Moderate |
Retained stones (time point unclear) | No statistically significant difference | Moderate |
Failure of procedure (time point unclear) | No statistically significant difference | Moderate |
Conversion to open surgery (time point unclear) | No statistically significant difference | Moderate |
Quality of life (time point unclear) | No statistically significant difference ᵃ | GRADE assessment not performed for this outcome ᵇ |
Hospital stay | Unknown ᶜ | GRADE assessment not performed for this outcome |
LC plus LCBDE versus LC plus postoperative ERCP | ||
Mortality (time point unclear) | Unknown ᵃ | GRADE assessment not performed for this outcome |
Total morbidity (time point unclear) | No statistically significant difference | Moderate |
Retained stones after primary intervention (time point unclear) | Favours intervention | Moderate |
Failure of procedure (time point unclear) | No statistically significant difference | Moderate |
Conversion to open surgery (time point unclear) | No statistically significant difference | Moderate |
Hospital stay | Unknown ᵃ | GRADE assessment not performed for this outcome |
Quality of life | - | None of the studies identified by the review assessed this outcome |
Note ᵃ Results reported narratively (see the Cochrane Clinical Answer for more details). ᵇ The Cochrane reviewers did not perform a GRADE assessment but the single RCT providing evidence for this outcome was at low risk of bias for all domains. ᶜ No meta-analysis was done for this outcome and the results from five RCTs were reported narratively. Two showed a shorter stay with LC + LCBDE compared with preoperative ERCP + LC; the other three found no statistically significant difference between groups.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- In adults with bile duct stones, how does surgical treatment compare with endoscopic treatment for improving outcomes?
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