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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(12): E1599-E1607
DOI: 10.1055/a-1958-2348
Review

Endoscopic sphincterotomy vs papillary large balloon dilation vs combination modalities for large common bile duct stones: a network meta-analysis

Muhammad Aziz‡
1   Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio
,
Zubair Khan‡
2   Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School, Houston, Texas
,
Hossein Haghbin
3   Division of Gastroenterology, Ascension providence Hospital, Southfield, Michigan, United States
,
Faisal Kamal
4   Division of Gastroenterology, University of California, San Francisco, California, United States
,
Sachit Sharma
5   Division of Gastroenterology, Virginia Commonwealth University, Richmond, Virginia, United States
,
Wade Lee-Smith
6   University of Toledo Libraries, University of Toledo, Toledo, Ohio, United States
,
Asad Pervez
7   Division of Gastroenterology, West Virginia University, Morgantown, West Virginia, United States
,
Yaseen Alastal
1   Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio
,
Ali Nawras
1   Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio
,
Nirav Thosani
2   Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School, Houston, Texas
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Abstract

Background and study aims The optimal technique for removal of large common bile duct (CBD) stones (≥ 10 mm) during endoscopic retrograde cholangiopancreatography (ERCP) remains unclear. We aimed to perform a comparative analysis between different endoscopic techniques.

Methods Adhering to PRISMA guidelines, a stringent search of the following databases through January 12, 2021, were undertaken: PubMed/Medline, Embase, Web of Science, and Cochrane. Randomized controlled trials comparing the following endoscopic techniques were included: (1) Endoscopic sphincterotomy (EST); (2) Endoscopic papillary large balloon dilation (EPLBD); and (3) EST plus large balloon dilation (ESLBD). Stone clearance rate (SCR) on index ERCP was the primary outcome/endpoint. Need for mechanical lithotripsy (ML) and adverse events were also evaluated as secondary endpoint. Random effects model and frequentist approach were used for statistical analysis.

Results A total of 16 studies with 2545 patients (1009 in EST group, 588 in EPLBD group, and 948 patients in ESLBD group) were included. The SCR was significantly higher in ESLBD compared to EST risk ratio [RR]: 1.11, [confidence interval] CI: 1.00–1.24). Lower need for ML was noted for ESLBD (RR: 0.48, CI: 0.31–0.74) and EPLBD (RR: 0.58, CI: 0.34–0.98) compared to EST. All other outcomes including bleeding, perforation, post-ERCP pancreatitis, stone recurrence, cholecystitis, cholangitis, and mortality did not show significant difference between the three groups. Based on network ranking, ESLBD was superior in terms of SCR as well as lower need for ML and adverse events (AEs).

Conclusions Based on network meta-analysis, ESLBD seems to be superior with higher SCR and lower need for ML and AEs for large CBD stones.

Supplementary material



Publication History

Received: 16 December 2021

Accepted after revision: 04 October 2022

Accepted Manuscript online:
10 October 2022

Article published online:
15 December 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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