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Comparison of endoscopic papillary large balloon dilation and endoscopic sphincterotomy for retrieval of choledocholithiasis: a meta-analysis of randomized controlled trials

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Endoscopic sphincterotomy (EST) is the most frequently used technique for removal of stones from the bile duct. In recent years, endoscopic papillary large balloon dilation (EPLBD) has been shown to be a safe and effective technique for the removal of large or difficult common bile duct stones. However, comparison of EPLBD and EST for effectiveness in bile duct stone removal has given inconsistent results. The present meta-analysis was carried out to compare the effect of EPLBD and EST in retrieval of choledocholithiasis.

Methods

A literature search was performed using Medline, PubMed, EMBase and the Cochrane Central Register of Controlled Trials (CENTRAL) for relevant articles published in English. A meta-analysis was performed on the retrieved studies.

Results

Seven randomized controlled trials and 790 patients were involved. EPLBD compared with EST resulted in similar outcomes for overall successful clearance rates of bile duct stones (97.35 vs. 96.35%, OR 1.28, 95% CI 0.58–2.82, P = 0.54), stone clearance in the first ERCP session (87.87 vs. 84.15%, OR 1.31, 95% CI 0.81–2.11, P = 0.21) and removal of large sized stones (OR 1.08, 95% CI 0.21–5.64, P = 0.49). EPLBD performed with either a short or a long ballooning time did not increase the bile duct stone clearance rate. EPLBD decreased overall usage of mechanical lithotripsy in the bile duct stone removal process (OR 0.51, 95% CI 0.30–0.86, P = 0.01). However, no significant difference was found between EPLBD and EST in the use of mechanical lithotripsy for the removal of large sized stones (OR 0.67, 95% CI 0.34–1.28, P = 0.22). Compared with EST, EPLBD did not show a short ERCP duration (WMD −0.75, 95% CI −1.57 to 0.08, P = 0.08). EPLBD was associated with fewer overall complications than EST (5.8 vs. 13.1%, OR 0.41, 95% CI 0.24–0.68, P = 0.0007). Hemorrhage occurred less frequently with EPLBD than with EST (OR 0.15, 95% CI 0.04–0.50, P = 0.002). There was no significant difference in post-ERCP pancreatitis, perforation and cholangitis.

Conclusions

EPLBD is an effective and safe method for the removal of large or difficult common bile stones. EPLBD should be considered as an alternative to EST for patients in whom EST could not be routinely performed. Based on EPLBD causing fewer cases of hemorrhaging, EPLBD is also recommended for removal of large or difficult common bile duct stones in patients with an underlying coagulopathy or need for anticoagulation following ERCP. The long-term prognosis of EPLBD need to be further investigated.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China

    Yadong Feng, Hong Zhu, Xiaoxing Chen, Shunfu Xu, Wenfang Cheng, Jinliang Ni & Ruihua Shi

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  1. Yadong Feng
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  2. Hong Zhu
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  3. Xiaoxing Chen
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  4. Shunfu Xu
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  5. Wenfang Cheng
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  6. Jinliang Ni
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  7. Ruihua Shi
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Corresponding authors

Correspondence to Xiaoxing Chen or Ruihua Shi.

Additional information

Y. Feng and H. Zhu contributed equally to this paper.

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Feng, Y., Zhu, H., Chen, X. et al. Comparison of endoscopic papillary large balloon dilation and endoscopic sphincterotomy for retrieval of choledocholithiasis: a meta-analysis of randomized controlled trials. J Gastroenterol 47, 655–663 (2012). https://doi.org/10.1007/s00535-012-0528-9

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  • DOI: https://doi.org/10.1007/s00535-012-0528-9

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