Copyright ©2014 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. May 14, 2014; 20(18): 5548-5556
Published online May 14, 2014. doi: 10.3748/wjg.v20.i18.5548
Endoscopic papillary large balloon dilation vs endoscopic sphincterotomy for retrieval of common bile duct stones: A meta-analysis
Piao-Piao Jin, Jian-Feng Cheng, Dan Liu, Mei Mei, Zhao-Qi Xu, Lei-Min Sun
Piao-Piao Jin, Lei-Min Sun, Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Jian-Feng Cheng, Internal Medicine, Division of Gastroenterology, Carolinas Medical Center, Charlotte, NC 28203, United States
Dan Liu, Department of Statistics, Texas A and M University, College Station, TX 77843, United States
Mei Mei, Doppler Ultrasonic Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
Zhao-Qi Xu, Fifth People’s Hospital of Yuhang District, Hangzhou 310016, Zhejiang Province, China
Author contributions: Jin PP designed the study, performed data analysis and drafted the manuscript as the first author; Cheng JF contributed to manuscript preparation, editing, revision and supervising the statistical analysis; Liu D revised the statistics and discussion; Mei M and Xu ZQ were responsible for data collection and analysis; Sun LM contributed to study design, discussion and edited the manuscript as the corresponding author.
Supported by Technology Foundation for Selected Overseas Chinese Scholar, Zhejiang Province, No. 188020-710903/016
Correspondence to: Lei-Min Sun, MD, PhD, Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Road, Hangzhou 310016, Zhejiang Province, China.
Telephone: +86-571-86006186 Fax: +86-571-86044817
Received: October 10, 2013
Revised: March 2, 2014
Accepted: March 12, 2014
Published online: May 14, 2014

AIM: To compare the efficacy and safety of endoscopic papillary large balloon dilation (EPLBD) with endoscopic sphincterotomy (EST) in retrieval of common bile duct stones (≥ 10 mm).

METHODS: PubMed, Web of Knowledge, EBSCO, the Cochrane Library, and EMBASE were searched for eligible studies. Randomized controlled trials (RCTs) that compared EPLBD with EST were identified. Data extraction and quality assessment were performed by two independent reviewers using the same criteria. Any disagreement was discussed with a third reviewer until a final consensus was reached. Pooled outcomes of complete bile duct stone clearance, stone clearance in one session, requirement for mechanical lithotripsy, and overall complication rate were determined using relative risk and 95%CI. The separate post-endoscopic retrograde cholangiopancreatography complications were pooled and determined with the Peto odds ratio and 95%CI because of the small number of events. Heterogeneity was evaluated with the chi-squared test with P≤ 0.1 and I2 with a cutoff of ≥ 50%. A fixed effects model was used primarily. A random effects model was applied when significant heterogeneity was detected. Sensitivity analysis was applied to explore the potential bias.

RESULTS: Five randomized controlled trials with 621 participants were included. EPLBD compared with EST had similar outcomes with regard to complete stone removal rate (93.7% vs 92.5%, P = 0.54) and complete duct clearance in one session (82.2% vs 77.7%, P = 0.17). Mechanical lithotripsy was performed less in EPLBD in the retrieval of whole stones (15.5% vs 25.2%, P = 0.003), as well as in the stratified subgroup of stones larger than 15 mm (24.2% vs 40%, P = 0.001). There was no statistically significant difference in the incidence of overall adverse events (7.9% vs 10.7%, P = 0.25), post-ERCP pancreatitis (4.0% vs 5.0%, P = 0.54), hemorrhage (1.7% vs 2.8%, P = 0.32), perforation (0.3% vs 0.9%, P = 0.35) or acute cholangitis (1.3% vs 1.3%, P = 0.92).

CONCLUSION: EPLBD could be advocated as an alternative to EST in the retrieval of large common bile duct stones.

Keywords: Endoscopic papillary large balloon dilation, Endoscopic sphincterotomy, Mechanical lithotripsy, Common bile duct stones, Meta analysis.

Core tip: Endoscopic papillary large balloon dilation (EPLBD) was as effective as endoscopic sphincterotomy in large common bile duct stone clearance. However, it had less requirement for endoscopic mechanical lithotripsy, even in stones larger than 15 mm. Besides, EPLBD could be conducted with limited or without precutting of the papilla which may be promising for application in patients with coagulopathy or with surgically modified anatomy. Further investigations are required to confirm this claim.