RT Journal Article SR Electronic T1 Systematic review and meta-analysis of gallstone disease treatment outcomes in early cholecystectomy versus conservative management/delayed cholecystectomy JF BMJ Open Gastroenterology JO BMJ Open Gastro FD BMJ Publishing Group Ltd SP e000675 DO 10.1136/bmjgast-2021-000675 VO 8 IS 1 A1 Bhavani Shankara Bagepally A1 Madhumitha Haridoss A1 Akhil Sasidharan A1 Kayala Venkata Jagadeesh A1 Nikhil Kumar Oswal YR 2021 UL http://bmjopengastro.bmj.com//content/8/1/e000675.abstract AB Background The effectiveness of early cholecystectomy for gallstone diseases treatment is uncertain compared with conservative management/delayed cholecystectomy.Aims To synthesise treatment outcomes of early cholecystectomy versus conservative management/delayed cholecystectomy in terms of its safety and effectiveness.Design We systematically searched randomised control trials investigating the effectiveness of early cholecystectomy compared with conservative management/delayed cholecystectomy. We pooled the risk ratios with a 95% CI, also estimated adjusted number needed to treat to harm.Results Of the 40 included studies for systematic review, 39 studies with 4483 patients are included in meta-analysis. Among the risk ratios of gallstone complications, pain (0.38, 0.20 to 0.74), cholangitis (0.52, 0.28 to 0.97) and total biliary complications (0.33, 0.20 to 0.55) are significantly lower with early cholecystectomy. Adjusted number needed to treat to harm of early cholecystectomy compared with conservative management/delayed cholecystectomy are, for pain 12.5 (8.3 to 33.3), biliary pancreatitis >1000 (50–100), common bile duct stones 100 (33.3 to 100), cholangitis (100 (25–100), total biliary complications 5.9 (4.3 to 9.1) and mortality >1000 (100 to100 000).Conclusions Early cholecystectomy may result in fewer biliary complications and a reduction in reported abdominal pain than conservative management.PROSPERO registration number 2020 CRD42020192612.No data are available. All the data is available in the online supplementary material.