Comparison of Outcomes between a Basket Catheter and a Balloon Catheter for Endoscopic Common Bile Duct Stone Removal

Abstract

BIntroduction: Evidence for the outcomes of endoscopic retrograde cholangiopancreatography (ERCP) between a basket catheter and a balloon catheter for endoscopic common bile duct stone (CBDS) removal is lacking. This study aimed to compare ERCP outcomes using a basket catheter and a balloon catheter for endoscopic CBDS removal. Methods: This multicenter retrospective study included 904 consecutive patients with native papilla who underwent endoscopic stone removal for CBDS ≤10 mm using a basket catheter and/or a balloon catheter at three institutions in Japan. ERCP outcomes between the basket and balloon groups were compared using inverse probability treatment weighting (IPTW) method. Results: ERCP-related adverse events occurred in 6.5% (29/449) and 7.7% (35/455) of patients in the basket and balloon groups, respectively (IPTW-adjusted P = 0.52). The incidences of post-ERCP pancreatitis (PEP), cholangitis, and perforation were similar in the basket and balloon groups (3.8% vs. 2.9%, 1.3% vs. 0.9%, and 0.7% vs. 0.7%, respectively). However, bleeding incidences were significantly higher in the balloon group than in the basket group (3.3% vs. 0.7%, IPTW-adjusted P = 0.012). Successful complete stone removal at one ERCP session using a single catheter was achieved in 17.8% (80/449) in the basket group and in 81.3% (370/455) in the balloon group (IPTW-adjusted P <0.001). Discussion: A balloon catheter is more likely to complete stone extraction for CBDS ≤ 10 mm with a single catheter at one endoscopic stone removal session. However, the risk for post-ERCP bleeding is higher in the balloon group than in the basket group.

Endoscopic Management of Difficult Biliary Stones: An Evergreen Issue

“…Both extraction devices are considered equally effective according to ESGE guidelines [3]. However, in a recent multicenter retrospective study with 904 patients who underwent ERCP for choledocholithiasis, balloon catheters exhibited significantly higher success rates for stone extraction during the first ERCP session when compared to basket catheters (81.3% vs. 17.8%; p < 0.001) [41]. Still, this study included only patients with small CBD stones ≤10 mm and its results should be re-evaluated in cases with difficult bile duct stones.…”