Basket versus balloon extraction for choledocholithiasis: a single center prospective single-blind randomized study

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Biliary Tract Interventions

Background:

• Choledocholithiasis management relies on endoscopic retrograde cholangiopancreatography (ERCP).
• Device selection for stone extraction is often based on endoscopist preference.
• Optimal device choice impacts ERCP efficacy and patient outcomes.

Purpose of the Study:

• To compare the efficacy of balloon versus basket catheters for bile duct stone extraction.
• To determine if balloon extraction is non-inferior to basket extraction for small stones.
• To evaluate secondary outcomes including procedure time and radiation dose.

Main Methods:

• A prospective, randomized controlled, non-inferiority study involving 180 patients.
• Patients were randomized to either a basket or balloon catheter group.
• Inclusion criteria: bile duct stones ≤10mm, common bile duct diameter ≤15mm.

Main Results:

• Balloon extraction was non-inferior to basket extraction (OR 3.35, p=0.031).
• Complete clearance rates were 84.1% for baskets vs. 94% for balloons (p=0.047).
• Balloon extraction was faster (4.06 min vs. 4.52 min, p=0.015) and used less radiation (1245.45 Gy vs. 1534.43 Gy, p=0.023).

Conclusions:

• Balloon catheters are a viable and effective alternative to basket catheters for bile duct stone extraction.
• Balloon extraction demonstrates non-inferiority, offering potential advantages in efficiency and radiation reduction.
• Findings support considering balloon catheters for ERCP stone removal, particularly for smaller stones.