Best Procedure for the Management of Common Bile Duct Stones via the Papilla: Literature Review and Analysis of Procedural Efficacy and Safety

Abstract

Background: Endoscopic management of common bile duct stones (CBDS) is standard; however, various techniques are performed via the papilla, and the best procedure in terms of both efficacy and safety has not been determined. Methods: Endoscopic procedures were classified into five categories according to endoscopic sphincterotomy (EST) and balloon dilation (BD): (1) EST, (2) endoscopic papillary BD (≤10 mm) (EPBD), (3) EST followed by BD (≤10 mm) (ESBD), (4) endoscopic papillary large BD (≥12 mm) (EPLBD), and (5) EST followed by large BD (≥12 mm) (ESLBD). We performed a literature review of prospective and retrospective studies to compare efficacy and adverse events (AEs). Each procedure was associated with different efficacy and AE profiles. Results: In total, 19 prospective and seven retrospective studies with a total of 3930 patients were included in this study. For EST, the complete stone removal rate at the first session, rate of mechanical lithotripsy (ML), and rate of overall AEs in EST were superior to EPBD, but a higher rate of bleeding was found for EST. Based on one retrospective study, complete stone removal rate at the first session, rate of ML, and rate of overall AEs were superior for ESBD vs. EST, and the rate of bleeding for the former was also lower. Complete stone removal rate at the first session and rate of ML for ESLBD were superior to those for EST, with no significant difference in rate of AEs. For EST vs. EPLBD, complete stone removal rate at the first session and rate of ML were superior for the latter. For EPLBD vs. ESLBD, the efficacy and safety were similar. Conclusions: ESBD is considered the best procedure for the management of small CBDS, but strong evidence is lacking. For large CBDS, both ESLBD and EPLBD are similar.

Clinical efficacy of laparoscopic cholecystectomy combined with endoscopic papillary balloon dilation in treatment of gallbladder stones with common bile duct stones: A retrospective study

“…To mitigate these complications, the EPBD technique was introduced for the management of GS combined with CBDS. This technique involves utilizing a biliary dilatation balloon to enlarge the biliary orifice without incising the papillary sphincter, as initially reported by Ishii et al [ 17 ].…”

Prophylactic cholecystectomy offers best outcomes following ERCP clearance of common bile duct stones: a meta-analysis

“…A recent meta-analysis by Ishii and colleagues, which compares BD and ES, identified that from collected data from the five RCTs and five NRCTs, the rate of complete CBD stone removal for the first session had a better outcome for endoscopic sphincterotomy followed by large balloon dilatation compared to endoscopic sphincterotomy (OR = 0.38, 95% CI 0.27–0.53, p < 0.01, I 2 = 57%). They found that BD increased post-procedure pancreatitis but was also accompanied by less bleeding [ 48 ]…”

Saline irrigation for reducing the recurrence of common bile duct stones after lithotripsy: a randomized controlled trial

“…Common bile duct stones (CBDS) are the most common digestive diseases, and endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) and/or endoscopic papillary balloon dilation (EPBD) is currently the first-line treatment for CBDS due to its effectiveness and minimal invasiveness. 1 , 2 , 3 However, the recurrence of CBDS after endoscopic stones extraction has been a troubling clinical problem. It has been reported that the recurrence rate of CBDS is between 4% and 24% after ERCP.…”