Comparison of endoscopic papillary large balloon dilation and endoscopic sphincterotomy for retrieval of choledocholithiasis: a meta-analysis of randomized controlled trials

Abstract

EPLBD is an effective and safe method for the removal of large or difficult common bile stones. EPLBD should be considered as an alternative to EST for patients in whom EST could not be routinely performed. Based on EPLBD causing fewer cases of hemorrhaging, EPLBD is also recommended for removal of large or difficult common bile duct stones in patients with an underlying coagulopathy or need for anticoagulation following ERCP. The long-term prognosis of EPLBD need to be further investigated.

Immediate balloon deflation method in endoscopic papillary large balloon dilation for extraction of difficult bile duct stones

“…Mechanical use was less frequent in EPLBD, although mechanical usage in large stones was similar. With respect to complications, EPLBD was associated with fewer complications [10].…”

“…However, ballooning time remains controversial in EPLBD [10]. In most EPLBD studies, the balloon was kept inflated for a few seconds to a minute after the waist of the balloon had disappeared on endoscopic and fluoro-scopic guidance.…”

“…Since then, several studies of EPLBD [2][3][4][5][6][7][8][9] for treatment of difficult bile duct stones have reported favorable outcomes and acceptable complication rates. In addition, a recent meta-analysis [10] reported that EPLBD should be considered as an alternative for patients in whom EST could not be routinely performed; it was also recommended for removal of large or difficult common bile duct stones in patients with an underlying coagulopathy or need for anticoagulation following endoscopic retrograde cholangiopancreatography (ERCP) because cases of hemorrhage in EPLBD are fewer than in EST.…”

“…However, so far, there has been no consensus with regard to ballooning time [10]. In most studies on EPLBD, the balloon was kept inflated for a certain period after the waist of the balloon had disappeared under endoscopic and fluoroscopic guidance.…”

La SMSO (Sphinctérotomie avec macrodilatation du sphincter d’Oddi) dans le traitement des gros calculs de la voie biliaire principale : Expérience de l’Hôpital Militaire de Rabat (Maroc)

“…Dansn otre expérience, la SMSO ap ermis, dans 5c as, l'extraction de gros calculs malgré la présence d'une disparité de calibre entre la portion distale de la VBP en aval du calcul et sa portion proximale en amont de celui-ci. La présence d'un diverticule ne paraîtp as être une contre indication à la SMSO,m ais doit inciter à une dilatation plus prudente [25]. La complication la plus courante de la SMSO reste le saignement, le plus souvent minime à modéré et traité dans la plupart des cas de façon conservatrice.…”