A Systematic Review and Meta-analysis of Basket or Balloon Catheter for the Retrieval of Choledocholithiasis

Abstract

Choledocholithiasis means the presence of gallstone inside the common bile duct (CBD). Removing the bile duct stones can be done surgically using endoscopic catheters. In this study, we aim to assess the safety and efficacy of basket catheters compared to balloon catheters at bile duct stone clearance. We searched four databases for clinical trial and cohort studies that compare basket catheter and balloon catheter in bile duct stone extraction. We extracted data from the included studies. These data were pooled as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI) using Review Manager software (version 5.3) and OpenMetaAnalyst software for zero-event outcomes. In a total of 728 patients, we find that the balloon catheter was better than the basket catheter regarding incomplete bile duct stone clearance (RR = 0.91, 95% CI [0.85, 0.98], P = 0.01). Regarding the number of the extracted stones by both catchers, the analysis favored the balloon catheter over the basket for clearance when less than four stones (RR = 0.91, 95% CI [0.85, 0.99], P = 0.02) but no significant difference for more than four stones (RR = 0.77, 95% CI [0.48, 1.24], P = 0.29). There was no significant difference between the two groups. The analysis revealed that the balloon catheter is better than the basket catheter for choledocholithiasis regarding the complete clearance of the stone. However, there was no significant difference regarding the safety outcome.

Comprehensive review on small common bile duct stones

“…A recent meta-analysis found that balloon catheters for cholelithiasis were superior to basket catheters for complete stone removal[ 9 ]. However, there are some limitations in the studies included in this meta-analysis.…”

“…Once a stone is captured in a basket, reliable extraction is usually ensured. More reliable traction associated with the basket catheter is cited as the main reason for its preferential use in Japan and Europe[ 5 , 9 ]. In the study by Ozawa et al [ 5 ], the balloon slipped past the stones and could not provide a sufficient traction force for stone extraction within 10 min in four patients in the balloon group, and the stones were successfully captured and withdrawn after exchange to the basket in all cases.…”

“…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 ].…”