Endoscopic sphincterotomy plus balloon dilation versus endoscopic sphincterotomy for choledocholithiasis: A meta‐analysis

Abstract

ESBD is feasible for the treatment of choledocholithiasis without increased risk of complications, causing less bleeding. However, it warrants more clinical trials to compare the efficacy and safety of ESBD and EST.

International consensus guidelines for endoscopic papillary large-balloon dilation

“…The initial success rate, which was defined as the rate of successful stone removal during the first ERCP session, of EPLBD with EST in the systematic review 18 was comparable to that of EST alone (84.0% vs 80.8%, P Z .131) in a meta-analysis by Weinberg et al 11 The initial www.giejournal.org Volume -, No. -: 2015 GASTROINTESTINAL ENDOSCOPY 5 success rate in EPLBD with EST was similar to that of EST alone in 1 retrospective cohort study, 20 in 4 of the 6 randomized, controlled trials [27][28][29][30] ; and in all 5 meta-analyses 16,[31][32][33]36 ; whereas it was significantly higher in EPLBD with EST than that in EST alone in another 2 retrospective cohort studies by Kim et al 25 and Rosa et al 26 and the remaining 2 randomized, controlled trials by Li at al 34 and Jun et al 35 The overall success rate of EPLBD with EST in the previously mentioned systematic review 18 was comparable to that of EST alone (96.5% vs 95.3%, P Z .141) in a previous meta-analysis. 11 The overall success rate of EPLBD with EST was similar to that of EST alone in 2 of 3 retrospective cohort studies 20,25 ; in all 6 randomized, controlled trials [27][28][29][30]34,35 and in all 5 meta-analyses, 16,[31][32][33]36 whereas it was significantly higher in EPLBD with EST than in EST alone in the remaining retrospective cohort study by Rosa et al 26 Based on these results, the initial and overall success rates of EPLBD with EST are comparable to, or somewhat better than, those of EST alone.…”

“…18 In the comparison of adverse events between results of a previous meta-analysis by Weinberg et al 11 of EST alone and those of this systematic review in EPLBD with EST, the rate of pancreatitis in patients who underwent EPLBD with EST was significantly lower than that in patients who underwent EST alone (4.3% vs 2.4%, P Z .006). 18 In all 6 randomized, controlled trials [27][28][29][30]34,35 and all 5 meta-analyses 16,[31][32][33]36 that were conducted to compare the clinical outcomes of EPLBD with EST and of EST alone, the rate of pancreatitis showed no statistical difference between them. Furthermore, the systematic review of 3 studies reported that only mild to moderate pancreatitis after EPLBD without EST occurred in 3.9% of 413 patients.…”

Large bile duct stones

“…Results also showed equivalent complication rates (OR = 0.61, 95% CI 0.17-2.25, P = 0.46), including pancreatitis (OR = 1.11, 95% CI 0.37-3.35, P = 0.86), but with less bleeding in the ESBD group (OR = 0.10, 95% CI 0.03-0.30, P ≤ 0.001) [23].…”

Factores asociados con el uso de litotripsia mecánica en pacientes con cálculos gigantes de la vía biliar: ¿puede la dilatación papilar con balón grande disminuir su requerimiento?

“…En nuestra serie, la DPBG fue un fuerte factor protector del uso de LM, tanto en el análisis multivariado como en la regresión logística. En cuanto a las complicaciones, la tasa global de eventos adversos (pancreatitis, sangrado y perforación) es más baja para la DPBG que para la EFT sola, lo cual fue observado en 4 metaanálisis que evaluaron una comparación de DPBG más EFT con EFT sola (14,19,21,22,23). En un estudio multicéntrico de casos y controles a gran escala de 946 pacientes, el análisis de los subgrupos mostró que los cálculos mayores de 16 mm, la presencia de cirrosis y la EFT completa (grande) fueron factores independientemente asociados con la presencia de eventos adversos.…”