title: Comparison of long-term outcomes after endoscopic sphincterotomy versus endoscopic papillary balloon dilation: a propensity score-based cohort analysis.
abstract: BACKGROUND
  Endoscopic sphincterotomy (ES) is widely performed in patients with common bile duct stones (CBDS). However, the long-term outcomes of patients following ES have not been sufficiently elucidated. Impaired papillary function following ES may result in additional late complications. In contrast, endoscopic papillary balloon dilation (EPBD)-another option for treating CBDS-is expected to preserve papillary function. This study aimed to compare the long-term outcomes of patients with CBDS treated with ES to those treated with EPBD in a large cohort. In addition, a subgroup analysis was performed, according to gallbladder (GB) status.
  
  
  METHODS
  A cohort study was performed using propensity score matching to reduce treatment selection bias. This involved the analysis of follow-up data for 1086 patients who underwent EPBD or ES for CBDS.
  
  
  RESULTS
  Propensity score matching extracted 246 pairs of patients. The median (interquartile range) follow-up period after EPBD or ES was 93.5 (46.8-129.2) months and 90 (42-139.3) months, respectively. The incidence of CBDS recurrence after EPBD and ES were 8.5 and 15.0 %, respectively. The hazard ratio (95 % CI) was 0.577 (0.338-0.986) (P = 0.044). Based on the status of the GB, the incidence of CBDS recurrence was significantly different between post-EPBD and post-ES in the group with cholecystectomy after EPBD/ES (P = 0.013).
  
  
  CONCLUSIONS
  The incidence of biliary complications was significantly lower in patients after EPBD than in those after ES, and this outcome appeared most markedly in patients who also underwent cholecystectomy.
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
authors.forename: Shinpei
authors.initials: S
authors.lastname: Doi
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yasuda
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Mukai
authors.forename: Takuji
authors.initials: T
authors.lastname: Iwashita
authors.forename: Shinya
authors.initials: S
authors.lastname: Uemura
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yamauchi
authors.forename: Masanori
authors.initials: M
authors.lastname: Nakashima
authors.forename: Seiji
authors.initials: S
authors.lastname: Adachi
authors.forename: Masahito
authors.initials: M
authors.lastname: Shimizu
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tomita
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Hisataka
authors.initials: H
authors.lastname: Moriwaki
mesh_terms: D000368:Aged; D002761:Cholangitis / Q000209:etiology; D002764:Cholecystitis / Q000209:etiology; D015331:Cohort Studies; D004106:Dilatation / Q000009:adverse effects / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D042882:Gallstones / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012008:Recurrence; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome