Outcomes of balloon vs basket catheter for clearance of choledocholithiasis: a systematic review and meta-analysis

Abstract

Aim: Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay for treatment of choledocholithiasis. It is unclear whether balloon or basket catheters are better for extraction of stones ≤10 mm in size. We performed a meta-analysis of studies comparing rates of complete stone extraction and adverse events after ERCP using balloon vs basket catheters for bile duct stones ≤10 mm in size. Methods: Cochrane database, PubMed, Web of Science, and Embase were searched from inception to October 2021. Randomized control trials comparing outcomes of balloon vs basket catheter were included. Data extraction of articles was carried out by 2 authors using predefined inclusion criteria. Metanalysis was carried out using the Revman 5.4.1. software using a random-effects model. Results: 3 studies with a total of 508 patients were included in the final analysis. For common bile duct stones ≤10 mm, balloon catheters had higher complete stone clearance rates than basket catheters [Relative risk 1.1, confidence interval 1.03, 1.18, p=0.006]. Heterogeneity among studies was low (Tau2=0.0; p=0.47, I2=0%). There was no difference in the rate of complications. Conclusion: Meta-analysis of 3 studies indicates that balloon catheters have a higher success rate compared to basket catheters for complete stone extraction for choledocholithiasis ≤10 mm with no significant difference in the rate of complications.

Comprehensive review on small common bile duct stones

“…Therefore, we cannot conclude that the basket catheter is inferior to a balloon catheter in the case of small CBD stones[ 5 , 34 - 36 ]. One meta-analysis study only included these three studies, but its conclusions were similar to those of a previous meta-analysis[ 10 ]. Ozawa et al [ 5 ] reported that small stones (maximum diameter, 6 mm) are an independent risk factor for failed stone removal; in their study, the basket failed to grasp a small stone in eight cases, and in four of which, the stones were successfully removed after an exchange with a balloon catheter.…”

“…We described papillary dilation, stone extraction, difficult cases, troubleshooting during stone extraction in small CBD stones, and complicated cases of cholangitis, cholecystolithiasis, or distal biliary stricture and summarized the European, American, and Japanese guidelines. Moreover, this review addressed the novel literatures on endoscopic papillary balloon dilatation (EPBD) dilation times to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP)[ 6 ], the duration of direct oral anticoagulants (DOAC) and dual antiplatelet therapy (DAPT) withdrawal to safely perform EST[ 7 , 8 ], EST with balloon dilation (ESBD), and the comparison of the effects of retrieval balloon and basket catheters for small CBD stone extraction[ 9 , 10 ].…”

Endoscopic Management of Difficult Biliary Stones: An Evergreen Issue

“…Similarly, a study published in 2022 demonstrated higher success rates with balloon catheters compared to basket catheters regarding ≤10 mm stone extraction [42]. Nevertheless, retrieval baskets are evolving and in 2023 an experimental study analyzed seven different types of basket catheters according to their radial and axial force measurements, in order to review their mechanical properties and promote basket development in the future [43].…”