Meta-analysis comparison of endoscopic papillary balloon dilatation and endoscopic sphincteropapillotomy

Zhao, Hua-Lu; He, Liang; Zhou, Dachen; Geng, Xiaoping; Pan, Faming

doi:10.3748/wjg.v19.i24.3883

Cited by 73 publications

(61 citation statements)

References 21 publications

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“…Nevertheless, EPBD is only effective for removal 1 3 of small to moderate bile duct stones (less than 8 mm in diameter) due to the biliary opening being smaller than that with EST [10,11]. In addition, the incidence rates of hyperamylasemia and acute pancreatitis appear to be significantly higher for EPBD than for EST [11,12].…”

Section: Introductionmentioning

confidence: 83%

Small endoscopic sphincterotomy combined with endoscopic papillary large-balloon dilation in the treatment of patients with large bile duct stones

Chu

Zhang

et al. 2016

Eur Surg

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Small endoscopic sphincterotomy combined with endoscopic papillary large-balloon dilation 1 1 3 SummaryBackground To compare the effectiveness and safety of the combination of endoscopic papillary large-balloon dilation (EPLBD) and small endoscopic sphincterotomy (SEST) with either EST or EPLBD alone in the treatment of large bile duct stones.Methods A total of 127 patients with large bile duct stones were enrolled and randomly divided into four treatment groups (the SEST + EPLBD group, the EPLBD + SEST group, the EST group, and the EPLBD group) in a 1:1:1:1 ratio. Evaluation variables included the success rates of complete stone removal, complete stone removal without the use of endoscopic mechanical lithotripsy (EML), and complete stone removal in one session, as well as the occurrence of short-and long-term postoperative complications. ResultsThe overall rate of stone clearance was quite similar among the four treatment groups. There was no significant difference in the rate of complete stone removal without the use of EML among these groups. However, the combination treatment groups required relatively fewer sessions than did the EPLBD group. The incidence rates of short-and long-term complications were relatively lower in the two combination groups than in the EST and EPLBD groups.Conclusions A combination of SEST and EPLBD appears to be safe and effective for patients with large bile duct stones. This combination may have potential safety advantages in comparison with EST or EPLBD alone.

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Section: Introductionmentioning

confidence: 83%

Small endoscopic sphincterotomy combined with endoscopic papillary large-balloon dilation in the treatment of patients with large bile duct stones

Chu

Zhang

et al. 2016

Eur Surg

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“…10 Because the extent of orifice dilation with EPBD is limited to a diameter of 10 mm, it is less successful than EST in removing bile duct stones. 11,12 Endoscopic papillary large balloon dilation (EPLBD) combined with EST was introduced in 2003 to facilitate the removal of large or difficult bile duct stones, 13 and the size of the large-diameter balloons used was 12 to 20 mm. Since then, EPLBD with limited or large EST has become rapidly and widely adopted, mainly in Asia.…”

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confidence: 99%

International consensus guidelines for endoscopic papillary large-balloon dilation

Kim

Seo

et al. 2016

Gastrointestinal Endoscopy

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“…The balloon dilation of the sphincter of Oddi might cause spasm, compression and edema of the distal pancreatic duct, which could result in the restriction of pancreatic juice flow and the occurrence of pancreatitis [26] . Another disadvantage of conventional EPBD is that it is difficult to remove larger stones because the biliary opening is not enlarged to the same degree as with EST [6,7] ; therefore, the application of EPBD is restricted to patients with small stones less than 10 mm in diameter [9] . EPLBD combined with limited EST, which was first proposed to facilitate the removal of large or multiple bile duct stones, has been proven safe and effective in patients with large bile duct stones [27] .…”

Section: Resultsmentioning

confidence: 99%

“…Because EPBD does not involve cutting the biliary sphincter, it possesses the advantages of preserving papillary sphincter function and reducing the chance of hemorrhage and perforation [3,4] . However, this procedure is associated with a high risk of pancreatitis [5] and with more frequent application of mechanical lithotripsy [6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

Small sphincterotomy combined with endoscopic papillary large balloon dilationvssphincterotomy alone for removal of common bile duct stones

Guo¹,

Meng²,

Duan³

et al. 2014

WJG

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AIM:To evaluate the efficacy and safety of endoscopic papillary large diameter balloon dilation (EPLBD) following limited endoscopic sphincterotomy (EST) and EST alone for removal of large common bile duct (CBD) stones. METHODS:We retrospectively compared EST + EPLBD (group A, n = 64) with EST alone (group B, n = 89) for the treatment of large or multiple bile duct stones. The success rate of stone clearance, procedure-related complications and incidents, frequency of mechanical lithotripsy use, and recurrent stones were recorded. RESULTS:There was no statistically significant difference between the two groups regarding periampullary diverticula (35.9% vs 34.8%, P > 0.05), pre-cut sphincterotomy (6.3% vs 6.7%, P > 0.05), size (12.1 ± 2.0 mm vs 12.9 ± 2.6 mm, P > 0.05) and number (2.2 ± 1.9 vs 2.4 ± 2.1, P > 0.05) of stones or the diameters of CBD (15.1 ± 3.3 mm vs 15.4 ± 3.6 mm, P > 0.05). There were no cases of perforation, acute cholangitis, or cholecystitis in the two groups. The rate of bleeding and the recurrence of CBD stones were significantly lower in group A than in group B [1/64 (1.6%) vs 5/89 (5.6%), P < 0.05; 1/64 (1.6%) vs 6/89 (6.7%), P < 0.05, respectively]. CONCLUSION:EST + EPLBD is an effective and safe endoscopic approach for removing large or multiple CBD stones. Key words: Choledocholithiasis; Endoscopic retrograde cholangiopancreatography; Endoscopic papillary balloon dilation; Endoscopic sphincterotomy Core tip: Endoscopic papillary large diameter balloon dilation (EPLBD) after limited endoscopic sphincterotomy (EST) is an effective and safe endoscopic approach to remove large or multiple common bile duct stones. Compared with EST alone, the rate of bleeding and recurrence of CBD stones were significantly lower in the EST + EPLBD group (1.6% vs 5.6%, P < 0.05; 1.6% vs 6.7%, P < 0.05, respectively). While the rates of overall stone removal and stone removal in the first session (96.9% vs 94.4%, P > 0.05; 90.6% vs 88.8%, P > 0.05, respectively) and the rates of post-endoscopic retrograde cholangiopancreatography pancreatitis and hyperamylasemia were not significantly different between the two groups (4.7% vs 4.5%, P > 0.05; 10.9% vs 10.1%, P > 0.05, respectively).Guo SB, Meng H, Duan ZJ, Li CY. Small sphincterotomy combined with endoscopic papillary large balloon dilation vs sphincterotomy alone for removal of common bile duct stones. World J Gastroenterol 2014; 20(47): 17962-17969 Available from: URL:

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Meta-analysis comparison of endoscopic papillary balloon dilatation and endoscopic sphincteropapillotomy

Abstract: Although the incidence of pancreatitis was higher, the overall stone clearance rate and risk of bleeding was lower with EPBD compared to EST.

Cited by 73 publications

References 21 publications

Small endoscopic sphincterotomy combined with endoscopic papillary large-balloon dilation in the treatment of patients with large bile duct stones

Small endoscopic sphincterotomy combined with endoscopic papillary large-balloon dilation in the treatment of patients with large bile duct stones

International consensus guidelines for endoscopic papillary large-balloon dilation

Small sphincterotomy combined with endoscopic papillary large balloon dilationvssphincterotomy alone for removal of common bile duct stones

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