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Endoscopic sphincterotomy plus balloon dilation versus endoscopic sphincterotomy for choledocholithiasis: A meta‐analysis
Author(s) -
Liu Yangyang,
Su Peizhu,
Lin Yinghao,
Lin Siheng,
Xiao Kun,
Chen Pingyan,
An Shengli,
Bai Yang,
Zhi Fachao
Publication year - 2013
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12192
Subject(s) - medicine , balloon dilation , pancreatitis , lithotripsy , randomized controlled trial , relative risk , odds ratio , surgery , meta analysis , gastroenterology , balloon , confidence interval
Background and Aim Endoscopic sphincterotomy ( EST ) alone and EST combined with balloon dilation ( ESBD ) are important endoscopic techniques for stone extraction. We were to conduct a meta‐analysis to compare the efficacy and safety of ESBD and EST . Methods Meta‐analysis was performed respectively on randomized controlled trials ( RCT s) and nonrandomized studies comparing the efficacy and safety of ESBD and EST . Results The results of three RCT s showed that stone removal in first session (relative risk [ RR ] 1.01, 0.92–1.11, P = 0.85) and the utility of endoscopic mechanical lithotripsy ( EML ) ( RR 0.78, 0.49–1.23, P = 0.29) were equivalent between ESBD and EST . ESBD has equivalent complications ( RR 0.61, 0.17–2.25, P = 0.46) and post‐ ERCP pancreatitis (Peto odds ratio [ OR ] 1.11, 0.37–3.35, P = 0.86), but less bleeding (Peto OR 0.10, 0.03–0.30, P < 0.0001). The analysis of six retrospective studies suggested higher initial success in stone removal ( RR 1.11, 1.02–1.20, P = 0.01) and less EML ( RR 0.32, 0.22–0.46, P < 0.00001) in ESBD group. Less complications ( RR 0.60, 0.44–0.83, P = 0.02) happened in ESBD group, but equivalent post‐ ERCP pancreatitis (Peto OR 0.65, 0.37–1.15, P = 0.14) and bleeding (Peto OR 0.60, 0.29–1.26, P = 0.18). For patients with stones ≥ 15 mm, ESBD required less EML ( RR 0.35, 0.24–0.51, P < 0.00001) and caused fewer complications ( RR 0.67, 0.38–0.92, P = 0.02). Conclusions ESBD is feasible for the treatment of choledocholithiasis without increased risk of complications, causing less bleeding. However, it warrants more clinical trials to compare the efficacy and safety of ESBD and EST .