Original articleSystematic reviews and meta-analysesBalloon Dilation With Adequate Duration Is Safer Than Sphincterotomy for Extracting Bile Duct Stones: A Systematic Review and Meta-analyses
Section snippets
Data Sources and Searches
This systematic review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline.15 The MEDLINE was searched for RCTs of EPBD for bile duct stone until end of August 2011 without language or date restriction by using the following keywords: endoscopic papillary balloon dilation/dilatation, endoscopic sphincteroplasty, endoscopic balloon sphincter dilation/dilatation, and endoscopic balloon dilation/dilatation. Cochrane Collaboration Central Register of
Results
All included RCTs have been published in full manuscript form. Outcomes and detailed characteristics are summarized in Table 1 and Supplementary Table 1. Eleven studies compared EPBD vs EST without significant small study bias (Supplementary Figure 2); four compared short EPBD (total n = 459) vs EST (total n = 464), and seven compared long EPBD (total n = 277) vs EST (total n = 279). Only one study compared long EPBD vs short EPBD.
Discussion
Although EPBD has a lower risk of post-ERCP bleeding1, 11 and long-term complications than EST11, 29 and is easier to perform in altered/difficult anatomy,30, 31 EPBD is reserved for patients with bleeding diathesis by current consensus because some studies reported a higher risk of pancreatitis,2, 7 and short dilation (≤1 minute) is recommended for presumably lower pancreatitis risk.1, 2, 12 However, our meta-analyses indicate that short EPBD duration increases rather than decreases the risk
Conclusions
Our meta-analyses suggest that compared with EST, treating bile duct stones with EPBD >1 minute may reduce bleeding/overall complications without increasing the risk of pancreatitis. Currently recommended EPBD with ≤1-minute duration has a higher pancreatitis risk than EPBD >1 minute and EST. EPBD with an adequate duration (around 5 minutes) has lower complication rates than the current standard of EST and may be used as the first-line treatment for bile duct stones.
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Conflicts of interest The authors disclose no conflicts.
Funding Supported by an International Joint Grant from the Royal Society, London, UK, and National Science Council, Taiwan, and by National Taiwan University Hospital.