Endoscopic balloon dilation of the biliary sphincter compared to endoscopic biliary sphincterotomy for removal of common bile duct stones during ERCP: a metaanalysis of randomized, controlled trials.
OBJECTIVE
To compare the effect of endoscopic balloon dilation (EPBD) of the papilla with that of endoscopic biliary sphincterotomy (EST) in the treatment of patients with common bile duct stones.


METHODS
Searches of computerized bibliographic and scientific citations, and review of citations in relevant primary articles. Eight fully published prospective, randomized trials in English that compared EPBD with EST for the removal of common bile duct stones were subjected to metaanalysis.


RESULTS
EPBD compared with EST resulted in similar outcomes with regards to overall successful stone removal (94.3% vs 96.5%) and overall complications (10.5% vs 10.3%). 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. 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 EST 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 cannot be routinely recommended at this time.
Baron
Todd H
TH
Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Medical Center, Rochester, Minnesota, USA.
Harewood
Gavin C
GC
D014670:Ampulla of Vater; D001659:Biliary Tract / Q000293:injuries; D002404:Catheterization / Q000009:adverse effects; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D002761:Cholangitis / Q000209:etiology; D002764:Cholecystitis / Q000209:etiology; D016145:Endoscopy, Digestive System; D042882:Gallstones / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects