Endoscopic sphincterotomy plus large-balloon dilation vs endoscopic sphincterotomy for choledocholithiasis: a...

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Biliary Tract Interventions

Background:

• Bile duct stones pose a significant clinical challenge, often requiring invasive procedures for removal.
• Endoscopic sphincterotomy (EST) is a standard treatment, but its efficacy can be limited by stone size and number.
• Large-balloon dilation (LBD) has emerged as an adjunct to EST to facilitate stone clearance.

Purpose of the Study:

• To conduct a meta-analysis comparing the efficacy and safety of LBD plus EST versus EST alone for bile duct stone removal.
• To evaluate outcomes including complete stone removal, procedural efficiency, and complication rates.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed.
• Databases searched included PubMed, EMBASE, Cochrane Library, and Science Citation Index.
• Data were pooled using fixed-effects or random-effects models based on heterogeneity.

Main Results:

• Six RCTs involving 835 patients were analyzed.
• EST plus LBD demonstrated significantly fewer overall complications (OR=0.53) and a lower risk of perforation (Peto OR=0.14) compared to EST alone.
• The use of mechanical lithotripsy was significantly reduced with the addition of LBD (OR=0.26), particularly for stones >15 mm (OR=0.15).
• No significant differences were observed in complete stone removal, first-session clearance, pancreatitis, bleeding, infection, or procedure time.

Conclusions:

• Endoscopic sphincterotomy with large-balloon dilation is an effective and safer method for removing large bile duct stones.
• The combination therapy reduces procedural complications and the need for adjunctive lithotripsy.
• LBD plus EST offers an improved therapeutic option for managing complex bile duct stone cases.