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

Table 4 Comparative outcomes and risk of bias across studies

Ref.	Effect size	95%CI	P value	Secondary outcomes	Subgroup analyses/notable findings	Risk of bias	Notes
Jin et al[12], 2016	NR (no OR/RR for recurrence in abstract)			Lower blood loss (LLH vs OLH)2; lower transfusion1	No significant difference in recurrence/complications between LLH and OLH	Some concern	Benefit in perioperative metrics; recurrence not different
Tsutsumi et al[13], 2017	AE difference (sDBE 10% vs PTCS 45%)1		0.025	LOS shorter with sDBE2 (10 days vs 35 days; P < 0.001)	Stone-free survival similar (P = 0.919)	Some concern	Direct method comparison after HJ; crossover allowed
Ishihara et al[14], 2021	NR (author multivariable HRs for recurrence reported in text)			Clearance, AEs, re-intervention reported	Multivariable model for recurrence risk	Some concern	Time-to-event recurrence over approximately 30 months
Torres et al[15], 2021	Recurrence proportion 7.8%			Complications 33.0%; mortality 0.7%	Higher recurrence in bilateral stones/HJ	Some concern	Multicenter non-Asian surgery cohort
Yan et al[16], 2024	Clearance 90.48%; recurrence 28.57%		-	MELD improvement2 (P < 0.05); survival described	Decompensated cirrhosis; transplant eligibility	High risk (small n, severity)	High-risk population; detailed follow-up
Hakuta et al[17], 2024	OR 10.4 (failed removal in past HJS)	2.99-36.5		AEs 9.9%; recurrence 17%, 20%, 31% at 1/3/5-year	Past HJS (> 10 years) drives technical failure	Some concern	Large HJS cohort; Kaplan-Meier recurrence

¹Categorical variable compared using χ² or Fisher’s exact test.

²Continuous variable compared using t-test or Mann-Whitney U test as reported by authors.

NR: Not reported; OR: Odds ratio; RR: Risk ratio; AE: Adverse event; sDBE: Short double-balloon enteroscopy; PTCS: Percutaneous transhepatic cholangioscopy; HR: Hazard ratio; HJS: Hepaticojejunostomy stricture; CI: Confidence interval; LLH: Laparoscopic left hepatectomy; OLH: Open left hepatectomy; LOS: Length of hospital stay; MELD: Model for End-Stage Liver Disease; HJ: Hepaticojejunostomy.