Impact of chronic proliferative cholangitis on stone recurrence and biliary strictures after intrahepatic stone treatment: A meta-analysis

Table 3 Endpoints and outcomes of individual studies (author-reported statistics)

Ref.	Endpoints assessed	Outcome summary
Jin et al[12], 2016	Stone clearance, recurrence, complications, transfusion, blood loss, LOS	LLH (n = 96) vs OLH (n = 105) showed lower blood loss (383 ± 281 mL vs 554 ± 517 mL; P = 0.005) and lower transfusion (8.3% vs 30.5%; P < 0.001). No significant differences were seen in operation time, hospital stay, postoperative complication rate, residual stone rate, or recurrent stone rate. Findings suggest laparoscopic resection can match open surgery in clearance and recurrence, with perioperative benefits. Specific recurrence percentages not stated in abstract. CPC not reported; likely CPC-negative surgical cohort
Tsutsumi et al[13], 2017	Technical/clinical success, adverse events, LOS, stone-free survival	Initial access success 100% (PTCS) vs 91% (sDBE). All 40 patients achieved clinical success after crossover when needed. Adverse events were lower with sDBE (10%) than PTCS (45%; P = 0.025). Median LOS for complete clearance was shorter with sDBE (10 days vs 35 days; P < 0.001). Stone-free probabilities were similar at 1-3 years (P = 0.919). Results favor sDBE on safety and LOS while maintaining comparable long-term stone control. CPC-enriched post-HJ cohort with anastomotic stricture
Ishihara et al[14], 2021	Complete removal, recurrence, adverse events, re-intervention, multivariable risk factors	In 90 HJ patients, complete removal and recurrence were tracked over a median of 30.5 months (IQR 14.7-55.5). Endoscopic adverse events were reported. Multivariable modeling identified factors associated with recurrence (e.g., stricture/stone burden as per abstract). The study provides time-to-event recurrence and standardized endoscopic adverse events, enabling comparison with other BE-ERCP series. Detailed percentages for clearance and AEs are summarized in the text and tables of the article. CPC-enriched cohort with recurrent cholangitis and anastomotic narrowing
Torres et al[15], 2021	Stone-free status, recurrence, complications, mortality, procedures	Among 127 resections, postoperative complications occurred in 33.0% (biliary fistula 13.3%; SSI 7.0%). Mortality was 0.7%. Recurrence was 7.8% overall, with higher risk in bilateral stones and/or with hepaticojejunostomy. Stone location and atrophy were detailed. The series demonstrates durable stone control after resection with low mortality but notable morbidity. Mostly CPC-negative resection cohort with definitive duct clearance
Yan et al[16], 2024	Technical success, stone clearance, MELD change, recurrence, survival	In 21 decompensated cirrhosis patients, technical success was 100%. Most stones were cleared (90.48%). MELD decreased at 3 months (10.81 ± 3.31 vs 17.24 ± 3.40; P < 0.05) and was lowest at 6 months (9.94 ± 4.31). Median follow-up was 18 months; recurrence was 28.57% (6/21). Thirteen patients survived without transplant; five died due to liver failure or cancer. CPC-proxy positive (cohort with recurrent cholangitis in cirrhosis)
Hakuta et al[17], 2024	Scope/stone removal success, adverse events, recurrence (1/3/5-year), risk factors	In 131 patients after HJS, scope insertion succeeded in 89% and complete stone removal in 73%. Early adverse events occurred in 9.9%. Recurrence after complete removal was 17% at 1 year, 20% at 3 years, and 31% at 5 years. Past HJS (> 10 years) predicted failed stone removal (OR = 10.4, 95%CI: 2.99-36.5). CPC-enriched post-HJS anatomy with stricture predisposition
Hakuta et al[17], 2024	Scope/stone removal success, adverse events, recurrence (1/3/5-year), risk factors	In 131 patients after HJS, scope insertion succeeded in 89% and complete stone removal in 73%. Early adverse events occurred in 9.9%. Recurrence after complete removal was 17% at 1 year, 20% at 3 years, and 31% at 5 years. Past HJS (> 10 years) predicted failed stone removal (OR = 10.4, 95%CI: 2.99-36.5). CPC-enriched post-HJS anatomy with stricture predisposition

Endpoints assessed and principal findings in each included observational study. LOS: Length of hospital stay; MELD: Model for End-Stage Liver Disease; LLH: Laparoscopic left hepatectomy; OLH: Open left hepatectomy; CPC: Chronic proliferative cholangitis; PTCS: Percutaneous transhepatic cholangioscopy; sDBE: Short double-balloon enteroscopy; HJ: Hepaticojejunostomy; IQR: Interquartile range; BE: Balloon-enteroscopy; ERCP: Endoscopic retrograde cholangiopancreatography; AE: Adverse event; SSI: Surgical site infection; HJS: Hepaticojejunostomy stricture; OR: Odds ratio; CI: Confidence interval.