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Sphincterotomy plus balloon dilation versus sphincterotomy alone for choledocholithiasis: a meta-analysis.
Shou Quan Dong1,2, Tikka Prabhjot Singh1,2, Qiu Zhao1,2
1Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China.
Endoscopy
|February 21, 2019
Summary
Endoscopic sphincterotomy plus balloon dilation (ESBD) offers superior efficacy and safety for removing large common bile duct stones compared to endoscopic sphincterotomy (EST) alone. ESBD also requires less mechanical lithotripsy and shorter procedure times.
Area of Science:
- Gastroenterology
- Endoscopic Procedures
- Biliary Tract Interventions
Background:
- Large common bile duct (CBD) stones pose a challenge for endoscopic removal.
- Endoscopic sphincterotomy plus balloon dilation (ESBD) is a potential treatment, but its efficacy and safety compared to endoscopic sphincterotomy (EST) alone are debated.
Purpose of the Study:
- To compare the efficacy and safety of ESBD versus EST for the removal of large CBD stones through a meta-analysis.
Main Methods:
- A systematic literature search was conducted on electronic databases up to July 2018.
- 18 studies involving 2789 patients were included.
- Pooled odds ratios (ORs) were calculated to compare stone clearance and complication rates.
Main Results:
- ESBD demonstrated a significantly higher stone removal rate than EST across all sessions (OR 2.68) and during the first session (OR 2.07).
- The ESBD group experienced fewer complications (OR 0.63) and required less mechanical lithotripsy (OR 0.38).
- Procedure times were also shorter in the ESBD group (mean difference -4.05 minutes).
Conclusions:
- ESBD is superior to EST alone for the effective and safe removal of large CBD stones.
- ESBD facilitates management of large stones with reduced need for mechanical lithotripsy and shorter procedure durations.
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