Endoscopic balloon sphincter dilation vs. sphincterotomy for common bile duct stones： a Metaanalysis

Abstract

Objective To compare the pros and cons of endoscopic papillary balloon dilation （EPBD） with those of endoscopic sphincterotomy （EST） in the treatment of common bile duct stones. Methods We searched The Cochrane library, Medline, Pubmed, Embase, CBM, CNKI, VIP and Wan Fang database in any language. RCTs that compared EPBD with EST for the removal of common bile duct stones were included from January 1983 to September 2012 and qualities of the trials were evaluated. Statistic analyses were carried out using RevMan 5.1 software. Results A total of 18 randomized trials with 2385 participants met our inclusion criteria. EPBD compared with EST resulted in similar outcomes with regards to stone removal on 1 st attempt, overall stone removal, perforation, total short-term complication, long-term cholangitis or mortality. EPBD carries a higher risk of panereatitis （RR = 1.99, 95% CI： 1.41-2. 81 ） and severe pancreatitis （RR = 4. 68,95 % CI： 1.36-16. 11 ） , and requires higher rates of mechanical lithotripsy （RR = 1.31,95% CI： 1.14-1.50）. Conversely, EPBD not only has statistically significant lower rates of bleeding （RR = 0. 14,95 % CI：0. 06-0. 34 ）, but also leads to significantly less long-term choleeystitis （RR = 0. 38,95%CI：0. 19-0. 76）, long-term stone recurrence （RR =0. 67,95% CI：0. 47-0. 96） and total longterm complications （RR =0. 52,95% CI：0. 40-0. 67）. Conclusion On the basis of lower rates of bleeding or long-term complications, EPBD should be the preferred strategy over EST for endoscopic management of common bile duct stones, however, the rate of panereatitis, especially the severe panereatitis is higher with EPBD. Key words: Choledocholithiasis ; Sphincterotomy, endoscopic ; Endoscopic papillary balloondilation; Meta-analysis