Efficacy and safety of topical vs. oral calcium channel blockers for chronic anal fissures: a systematic review and meta-analysis.

This analysis focused on the remaining three high-quality RCTs (n = 217), revealing strengthened evidence for topical CCBs: the odds ratio for unhealed fissures increased to 3.12 (95% CI = 1.78–5.47, p < 0.0001), while the previously nonsignificant difference in side effects became highly significant (OR = 13.16, 95% CI = 5.05–34.3, p < 0.00001) with resolved heterogeneity (I 2 = 0%).

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These findings represent a significant contrast to the initial analysis, where the difference in side effects between the two groups did not reach statistical significance, likely due to the confounding influence of the excluded study.

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