Professor Yang Bai, Fachao Zhi, Institute of Digestive Diseases, Nan Fang Hospital, 1838 North Guangzhou Avenue, Guangzhou City, Guangdong Province, China. Email: [email protected]Search for more papers by this author

Yang Bai,

Corresponding Author

Yang Bai

Institute of Digestive Diseases, Nanfang Hospital, Guangzhou, China

Yangyang Liu,

Yangyang Liu

Institute of Digestive Diseases, Nanfang Hospital, Guangzhou, China

Search for more papers by this author

Peizhu Su,

Peizhu Su

Institute of Digestive Diseases, Nanfang Hospital, Guangzhou, China

Search for more papers by this author

Siheng Lin,

Siheng Lin

Institute of Digestive Diseases, Nanfang Hospital, Guangzhou, China

Search for more papers by this author

Kun Xiao,

Kun Xiao

Institute of Digestive Diseases, Nanfang Hospital, Guangzhou, China

Search for more papers by this author

Pingyan Chen,

Pingyan Chen

Biostatistics Unit, Nan Fang Medical University, Guangzhou, China

Search for more papers by this author

Shengli An,

Shengli An

Biostatistics Unit, Nan Fang Medical University, Guangzhou, China

Search for more papers by this author

Fachao Zhi,

Corresponding Author

Fachao Zhi

Institute of Digestive Diseases, Nanfang Hospital, Guangzhou, China

Yang Bai,

Corresponding Author

Yang Bai

Institute of Digestive Diseases, Nanfang Hospital, Guangzhou, China

First published: 13 September 2011

https://doi.org/10.1111/j.1440-1746.2011.06912.x

Citations: 44

Conflict of Interest Disclosure: All authors disclosed no financial relationship relevant to the publication.

Specific author contributions: Study concept and design: Yang Bai, Yangyang Liu; Bibliographic search, extraction of data, and drawing of the database: Siheng Lin, Kun Xiao; analysis and interpretation of the data: Pingyan Chen, Shengli An; drafting of the manuscript: Yangyang Liu, Peizhu Su; critical revision of the article for important intellectual content, final approval of the article: Fachao Zhi.

Share a link

Email
Wechat
Bluesky

Abstract

Background and Aim: Endoscopic papillary balloon dilatation (EPBD) and endoscopic sphincterotomy (EST) are two common nonsurgical treatments endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. The aim of this study was to compare the efficacy and safety of EPBD and EST in the treatment for choledocholithiasis, confining the analysis to work reported in the last decade.

Methods: The rate of overall postoperative complications was chosen as the primary outcome, and 10 other outcomes were secondary outcomes. Relative risk (RR) or Peto odds ratio (OR) were computed as the measures of pooled effects. We planned sensitivity analyses a priori for examining the change in robustness of the sensitivity to excluding studies with some inappropriate objects, technique defects or without full-text acquisition.

Results: For complete stone removal, EPBD was similar to EST (95% vs. 96%, P = 0.36) and overall postoperative complications (14.0% vs. 11.7%, P = 0.53). The incidence of post-ERCP cholangitis (2.5% vs. 1.8%, P = 0.40), basket impaction (0.9% vs. 0%, P = 0.16) and perforation (0.0% vs. 0.4%, P = 0.17) were equivalent between EPBD and EST. On the other hand, EPBD caused more post-ERCP pancreatitis (PEP) (9.4% vs. 3.3%, P < 0.00001), but less hemorrhage (0.1% vs. 4.2%, P < 0.00001). People undergoing EPBD required more use of endoscopic mechanical lithotripsy (35.0% vs. 26.2%, P = 0.0004). The results of sensitivity analyses showed no substantial change.

Conclusion: EPBD is comparable to EST for stone extraction, though it requires more endoscopic mechanical lithotripsy (EML). EPBD may outweigh EST for patients with coagulopathy; however, it may cause more PEP.

References

1 Yasuda I. Management of the bile duct stone: current situation in Japan. Dig. Endosc. 2010; 22: S76–8.
10.1111/j.1443-1661.2010.00957.x
PubMed Web of Science® Google Scholar
2 Staritz M, Ewe K, Meyer ZBK. Endoscopic papillary dilation (EPD) for the treatment of common bile duct stones and papillary stenosis. Endoscopy 1983; 15 (Suppl. 1): 197–8.
10.1055/s-2007-1021507
PubMed Web of Science® Google Scholar
3 May GR, Cotton PB, Edmunds SE et al. Removal of stones from the bile duct at ERCP without sphincterotomy. Gastrointest. Endosc. 1993; 39: 749–54.
10.1016/S0016-5107(93)70258-8
CAS PubMed Web of Science® Google Scholar
4 Katanuma A, Maguchi H, Osanai M et al. Complications and risk management of endoscopic papillary balloon dilatation. Dig. Endosc. 2007; 19: S68–71.
10.1111/j.1443-1661.2007.00731.x
Web of Science® Google Scholar
5 Weinberg BM, Shindy W, Lo S. Endoscopic balloon sphincter dilation (sphincteroplasty) versus sphincterotomy for common bile duct stones. Cochrane Database Syst. Rev. 2006; (4): D4890.
Google Scholar
6 Jadad AR, Moore RA, Carroll D et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control. Clin. Trials 1996; 17: 1–12.
10.1016/0197-2456(95)00134-4
CAS PubMed Google Scholar
7 Higgins JP, Thompson SG, Deeks JJ et al. Measuring inconsistency in meta-analyzes. BMJ 2003; 327: 557–60.
10.1136/bmj.327.7414.557
PubMed Google Scholar
8 Lijmer JG, Bossuyt PMM, Heisterkamp SH. Exploring sources of heterogeneity in systematic reviews of diagnostic tests. Stat. Med. 2002; 21: 1525–37.
10.1002/sim.1185
PubMed Web of Science® Google Scholar
9 Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J. Nat. Cancer Inst. 1959; 22: 719–48.
CAS PubMed Web of Science® Google Scholar
10 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control. Clin. Trials 1986; 7: 177–88.
10.1016/0197-2456(86)90046-2
CAS PubMed Google Scholar
11 Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (Updated February 2008) [Document on the Internet]. The Cochrane Library. Issue 2, Chichester, UK: John Wiley&Sons Ltd, 2008. Cited Apr 2008. Available from URL: http://www.cochrane-handbook.org/
10.1002/9780470712184
Google Scholar
12 Yusuf S, Peto R, Lewis J et al. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog. Cardiovasc. Dis. 1985; 27: 335–71.
10.1002/9780470693926.ch15
CAS PubMed Web of Science® Google Scholar
13 Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50: 1088–101.
10.2307/2533446
CAS PubMed Web of Science® Google Scholar
14 Watanabe H, Yoneda M, Tominaga K et al. Comparison between endoscopic papillary balloon dilatation and endoscopic sphincterotomy for the treatment of common bile duct stones. J. Gastroenterol. 2007; 42: 56–62.
10.1007/s00535-006-1969-9
PubMed Web of Science® Google Scholar
15 Lin CK, Lai KH, Chan HH et al. Endoscopic balloon dilatation is a safe method in the management of common bile duct stones. Dig. Liver Dis. 2004; 36: 68–72.
10.1016/j.dld.2003.09.014
CAS PubMed Web of Science® Google Scholar
16 Tanaka S, Sawayama T, Yoshioka T. Endoscopic papillary balloon dilation and endoscopic sphincterotomy for bile duct stones: long-term outcomes in a prospective randomized controlled trial. Gastrointest. Endosc. 2004; 59: 614–18.
10.1016/S0016-5107(04)00157-9
PubMed Web of Science® Google Scholar
17 Disario JA, Freeman ML, Bjorkman DJ et al. Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology 2004; 127: 1291–9.
10.1053/j.gastro.2004.07.017
PubMed Web of Science® Google Scholar
18 Vlavianos P, Chopra K, Mandalia S et al. Endoscopic balloon dilatation versus endoscopic sphincterotomy for the removal of bile duct stones: a prospective randomised trial. Gut 2003; 52: 1165–9.
10.1136/gut.52.8.1165
CAS PubMed Web of Science® Google Scholar
19 Natsui M, Narisawa R, Motoyama H et al. What is an appropriate indication for endoscopic papillary balloon dilation? Eur. J. Gastroenterol. Hepatol. 2002; 14: 635–40.
10.1097/00042737-200206000-00008
PubMed Web of Science® Google Scholar
20 Bergman JJ, van Berkel AM, Bruno MJ et al. Is endoscopic balloon dilation for removal of bile duct stones associated with an increased risk for pancreatitis or a higher rate of hyperamylasemia? Endoscopy 2001; 33: 416–20.
10.1055/s-2001-14424
CAS PubMed Web of Science® Google Scholar
21 Bergman JJ, van Berkel AM, Bruno MJ et al. A randomized trial of endoscopic balloon dilation and endoscopic sphincterotomy for removal of bile duct stones in patients with a prior Billroth II gastrectomy. Gastrointest. Endosc. 2001; 53: 19–26.
10.1067/mge.2001.110454
CAS PubMed Web of Science® Google Scholar
22 Fujita N, Maguchi H, Komatsu Y et al. Endoscopic sphincterotomy and endoscopic papillary balloon dilatation for bile duct stones: a prospective randomized controlled multicenter trial. Gastrointest. Endosc. 2003; 57: 151–5.
10.1067/mge.2003.56
PubMed Web of Science® Google Scholar
23 Arnold JC, Benz C, Martin WR et al. Endoscopic papillary balloon dilation vs. sphincterotomy for removal of common bile duct stones: a prospective randomized pilot study. Endoscopy 2001; 33: 563–7.
10.1055/s-2001-15307
CAS PubMed Web of Science® Google Scholar
24 Igarashi Y, Yasuda I. Risk management for endoscopic treatment for common bile duct stones: endoscopic sphincterotomy and endoscopic papillary balloon dilation. Dig. Endosc. 2007; 19: 40–3.
10.1111/j.1443-1661.2007.00728.x
Web of Science® Google Scholar
25 Park DH, Kim M, Lee SK et al. Endoscopic sphincterotomy versus endoscopic papillary balloon dilatation for choledocholithiasis in liver cirrhosis with coagulopathy. Gastrointest. Endosc. 2004; 60: 181–5.
10.1016/S0016-5107(04)01554-8
Web of Science® Google Scholar
26 Kojima Y, Nakagawa H, Miyata A et al. Long-term prognosis of bile duct stones: endoscopic papillary balloon dilatation versus endoscopic sphincterotomy. Dig. Endosc. 2010; 22: 21–4.
10.1111/j.1443-1661.2009.00913.x
CAS PubMed Web of Science® Google Scholar
27 Liao WC, Huang SP, Wu MS et al. Comparison of endoscopic papillary balloon dilatation and sphincterotomy for lithotripsy in difficult sphincterotomy. J. Clin. Gastroenterol. 2008; 42: 295–9.
PubMed Web of Science® Google Scholar
28 Toda N, Saito K, Wada R et al. Endoscopic sphincterotomy and papillary balloon dilation for bile duct stones. Hepatogastroenterology. 2005; 52: 700–4.
PubMed Web of Science® Google Scholar
29 Attila T, May GR, Kortan P. Nonsurgical management of an impacted mechanical lithotriptor with fractured traction wires: endoscopic intracorporeal electrohydraulic shock wave lithotripsy followed by extra-endoscopic mechanical lithotripsy. Can. J. Gastroenterol. 2008; 22: 699–702.
10.1155/2008/798527
PubMed Web of Science® Google Scholar
30 Fujita R, Yamamura M, Fujita Y. Combined endoscopic sphincterotomy and percutaneous transhepatic cholangioscopic lithotripsy. Gastrointest. Endosc. 1988; 34: 91–4.
10.1016/S0016-5107(88)71270-5
CAS PubMed Web of Science® Google Scholar
31 Tsujino T, Kawabe T, Isayama H et al. Efficacy and safety of low-pressured and short-time dilation in endoscopic papillary balloon dilation for bile duct stone removal. J. Gastroenterol. Hepatol. 2008; 23: 867–71.
10.1111/j.1440-1746.2007.05267.x
CAS PubMed Web of Science® Google Scholar
32 Tsujino T, Isayama H, Komatsu Y et al. Risk factors for pancreatitis in patients with common bile duct stones managed by endoscopic papillary balloon dilation. Am. J. Gastroenterol. 2005; 100: 38–42.
10.1111/j.1572-0241.2005.40638.x
PubMed Web of Science® Google Scholar
33 Nakagawa H, Ohara K. Safeguards against acute pancreatitis associated with endoscopic papillary balloon dilatation. J. Hepatobiliary. Pancreat. Surg. 2006; 13: 75–9.
10.1007/s00534-005-1061-5
CAS PubMed Web of Science® Google Scholar
34 Bergman JJ, van der Mey S, Rauws EA et al. Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age. Gastrointest. Endosc. 1996; 44: 643–9.
10.1016/S0016-5107(96)70045-7
PubMed Web of Science® Google Scholar
35 Bergman JJ, van Berkel AM, Groen AK et al. Biliary manometry, bacterial characteristics, bile composition, and histologic changes fifteen to seventeen years after endoscopic sphincterotomy. Gastrointest. Endosc. 1997; 45: 400–5.
10.1016/S0016-5107(97)70151-2
CAS PubMed Web of Science® Google Scholar
36 Rolny P, Andren-Sandberg A, Falk A. Recurrent pancreatitis as a late complication of endoscopic sphincterotomy for common bile duct stones: diagnosis and therapy. Endoscopy 2003; 35: 356–9.
10.1055/s-2003-38137
CAS PubMed Web of Science® Google Scholar

Citing Literature

Volume27, Issue3

March 2012

Pages 464-471

Endoscopic papillary balloon dilatation versus endoscopic sphincterotomy in the treatment for choledocholithiasis: A meta-analysis

Abstract

References

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Endoscopic papillary balloon dilatation versus endoscopic sphincterotomy in the treatment for choledocholithiasis: A meta-analysis

Abstract

References

Citing Literature

References

Related

Information