Endoscopic Balloon Dilation of the Biliary Sphincter Compared to Endoscopic Biliary Sphincterotomy for Removal of Common Bile Duct Stones During ERCP: A Meta-analysis of Randomized, Controlled Trials

Abstract

Introduction: Endoscopic balloon dilation of the papilla (EPBD) has gained popularity outside the United States as an alternative to endoscopic sphincterotomy (ES) for endoscopic removal of common bile duct stones. The potential advantages of EPBD over ES are the avoidance of short-term complications of bleeding and perforation, while preserving the biliary sphincter. The aim of this study was to compare the effect of EPBD with ES in the treatment of patients with common bile duct stones. Methods: All computerized bibliographic and scientific citations were searched. Eight fully published prospective, randomized trials in the English literature that compared EPBD with ES for removal of common bile duct stones in 1,106 patients were subjected to meta-analysis. Results: EPBD and ES resulted in similar outcomes with regards to overall successful stone removal (94.3% vs. 96.5%, p = n.s.) and overall complications (10.5% vs. 10.3%, p = n.s.). Bleeding occurred less frequently with EPBD, 0% vs. 2.0%, p = 0.001. Post-ERCP pancreatitis occurred more commonly in the EPBD group, 7.4% vs. 4.3%, p = 0.05. No significant differences were seen in the rates of perforation or infection. The number of endoscopic treatment sessions required to achieve stone removal was similar in both groups although patients undergoing EPBD were more likely to require mechanical lithotripsy for stone extraction, 20.9% vs. 14.8%, p = 0.014. Conclusions: On the basis of lower rates of bleeding, EPBD should be the preferred strategy over ES for endoscopic removal of common bile duct stones in patients with coagulopathy. Although EPBD is theoretically attractive for use in young patients for biliary sphincter preservation, the rate of pancreatitis is higher with EPBD and it therefore cannot be routinely recommended at this time.