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Efficacy and safety of three endoscopic techniques for small common bile duct stones (≤ 10 mm): a multicenter, retrospective, cohort study with propensity score matching

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Abstract

Background

Endoscopic retrograde cholangiopancreatography (ERCP) is a major option for common bile duct (CBD) stones. Endoscopic sphincterotomy (EST), endoscopic papillary balloon dilatation (EPBD), and endoscopic sphincterotomy plus balloon dilatation (ESBD) are procedures for opening the bile duct orifice to extract CBD stones during ERCP. The optimal method for extracting small CBD stones (≤ 10 mm) has not yet been proposed. We aimed to compare the efficacy and safety of these three techniques in extracting small CBD stones.

Methods

ERCP for small stones was performed between January 2009 and November 2020 at three tertiary care centers. The incidence of post-ERCP pancreatitis (PEP) was compared among EST, EPBD, and ESBD groups. First and overall success rates of stone extraction, utilization rate of mechanical lithotripsy, and other ERCP complications such as bleeding, perforation, infection, and hyperamylasemia were compared.

Results

A total of 2181 patients were enrolled between January 2009 and November 2020. The proportion of young patients (≤ 45 years) in EPBD group was more than those in EST and ESBD group. Stone size in ESBD group was much larger than EST and EPBD group. After propensity score matching, the success rates of first and overall stone extraction in the three groups were high, and the rates of mechanical lithotripsy were low, with no significant difference. The PEP incidences showed no differences among the three groups. The incidence of bleeding complication in EST group was higher than that in EPBD group. No significant differences were observed in other complications between EPBD group and ESBD group. ESBD group had higher incidence of overall, infection, and hyperamylasemia complications than EST group.

Conclusion

EPBD is equivalent to ESBD in stone removal efficiency and complication rate, but brings a lower bleeding risk than EST. Therefore, we recommend EPBD as the first choice for small CBD stones.

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Funding

This work was supported by Grants from the key project for Social Development in Jiangsu Province of China (No. BE2020784), the National Natural Science Foundation of China (No. 81970499), and the Postgraduate Research and Practice Innovation Program of Jiangsu Province (KYCX20_1404).

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Author notes

  1. Qiang Ye and Jin Zhang have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No. 300 of Guangzhou Road, Nanjing, 210029, China

    Qiang Ye, Xiaoying Zhou, Chang Zhu, Wenjie Li & Guoxin Zhang

  2. First Clinical Medical College, Nanjing Medical University, Nanjing, 210029, China

    Qiang Ye, Chang Zhu & Wenjie Li

  3. Department of Respiratory, Zhenjiang First People’s Hospital, Zhenjiang, Jiangsu, 212000, China

    Jin Zhang

  4. Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, China

    Xilong Ou

  5. Department of Gastroenterology, Zhenjiang First People’s Hospital, Zhenjiang, Jiangsu, 212000, China

    Jun Yao

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  1. Qiang Ye
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Correspondence to Jun Yao or Guoxin Zhang.

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Qiang Ye, Jin Zhang, Xilong Ou, Xiaoying Zhou, Chang Zhu, Wenjie Li, Jun Yao, and Guoxin Zhang have no conflicts of interest or financial ties to disclose.

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Ye, Q., Zhang, J., Ou, X. et al. Efficacy and safety of three endoscopic techniques for small common bile duct stones (≤ 10 mm): a multicenter, retrospective, cohort study with propensity score matching. Surg Endosc 37, 1863–1869 (2023). https://doi.org/10.1007/s00464-022-09436-y

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