Endoscopy 2019; 51(08): 763-771
DOI: 10.1055/a-0848-8271
Review
© Georg Thieme Verlag KG Stuttgart · New York

Sphincterotomy plus balloon dilation versus sphincterotomy alone for choledocholithiasis: a meta-analysis

Shou Quan Dong
1  Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
2  The Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
,
Tikka Prabhjot Singh
1  Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
2  The Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
,
Qiu Zhao
1  Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
2  The Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
,
Juan Juan Li
1  Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
2  The Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
,
Hong Ling Wang
1  Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
2  The Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
› Author Affiliations
Further Information

Publication History

submitted 10 October 2017

accepted after revision 15 January 2019

Publication Date:
20 February 2019 (eFirst)

Abstract

Background Endoscopic sphincterotomy plus balloon dilation (ESBD) is considered to be a promising method for the removal of large common bile duct (CBD) stones. However, when compared with endoscopic sphincterotomy (EST) alone, the efficacy and safety of ESBD remain controversial. This meta-analysis aimed to compare the efficacy and safety of ESBD vs. EST for the removal of large CBD stones.

Methods Electronic databases were searched up to 15 July 2018 for literature that compared ESBD with EST for the removal of CBD stones. Pooled odds ratios (ORs) of the stone clearance rate and the complication rate were used to compare the efficacy and safety of ESBD vs. EST.

Results A total of 18 studies with 2789 patients were included. The results showed that the stone removal rate was much higher in the ESBD group than in the EST group, both across all endoscopic retrograde cholangiopancreatography (ERCP) sessions (OR 2.68, 95 % confidence interval [CI] 1.79 to 4.01) and during the first ERCP session (OR 2.07, 95 %CI 1.37 to 3.12). The ESBD group had fewer complications than EST alone (OR 0.63, 95 %CI 0.47 to 0.85). Moreover, the ESBD group needed less mechanical lithotripsy (OR 0.38, 95 %CI 0.24 to 0.61) and had a shorter procedure time (mean difference – 4.05, 95 %CI – 7.02 to – 1.09) than EST alone.

Conclusion The efficacy and safety of ESBD were superior to those of EST for the removal of large CBD stones. Moreover, less mechanical lithotripsy and shorter procedure times were needed with ESBD to manage large stones.

Fig. 1s – 4s, Table 1s – 5s