Abstract
Purpose: Endoscopic sphincterotomy (ES) is the traditional technique for removal of stones from the bile duct. ES carries an increased risk of bleeding, perforation, bile duct stenosis and ascending cholangitis. Recently, minimal endoscopic sphincterotomy with large balloon dilation has been shown to be a safe and effective technique for the removal of large (diameter >10mm)or difficult common bile duct stones. However, comparison of ES and limited ES plus papillary large balloon dilatation (ESPLBD) for bile duct stone clearance has yielded inconsistent results. The purpose of this study is to compare the effect of ESPLBD Versus EST alone in the retrieval of CBD stones and post procedural complications. Methods: Two authors independently conducted a comprehensive search on Medline, PubMed, EMBase and the Cochrane Central Register of Controlled Trials (CENTRAL) for relevant articles on the subject. Only studies published in English were included in the analysis. A random effect meta-analysis was performed. Publication bias was assessed using Begg's and Egger's tests. Results: Six studies involving 767 individuals were included in the analysis. The mean age of study participants was similar in both study arms (70.29 Vs 70.1, P = 0.92) ESPLBD compared to ES had similar outcomes for overall (OR 1.0; 95% CI 0.98-1.03, P = 0.92), and stone clearance in the first ERCP session (OR 1.06; 95% CI 1.00-1.13). Table 1 summarizes the differences between each study arm with regards to stone clearance, and complications of procedure (post-ERCP pancreatitis, cholangitis, bleeding and perforation). Mechanical Lithotripsy was required more frequently in the ES group (OR 0.58; 95% CI 0.44-0.78, P <0.001). ESPLBD did not significantly increase the duration of the procedure. There was no statistically significant difference in number of stones (2.7 vs. 2.5; P 0.63), number of ERCPs required (2 vs. 2; P =0.70), stone size (17.18 vs. 17.24; P = 0.97) and diameter of CBD (17.6 vs. 17.72; P = 0.93) in both study arms. There was some evidence of heterogeneity for overall stone clearance but no evidence of publication bias. Conclusion: Minimal ESPLBD is an effective and safe alternative to EST alone for the removal of large common bile duct stones. ESPLBD reduces the need for mechanical lithotripsy but offers no additional advantage over EST alone in overall stone clearance or post procedural complications.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call