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Endoscopic sphincterotomy with large balloon dilation versus endoscopic sphincterotomy for bile duct stones: a systematic review and meta-analysis.

Xu L, Kyaw MH, Tse YK, Lau JY - Biomed Res Int (2015)

Bottom Line: No statistical difference was found between EPLBD and EST for stone removal rate.EPLBD and EST have similar efficacy and safety for bile duct stones clearance.With larger stones, EPLBD can reduce requirement of mechanical lithotripsy.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Ningbo No. 1 Hospital, Ningbo 315010, China.

ABSTRACT

Unlabelled: The safety and efficacy of endoscopic sphincterotomy with large balloon dilation (EPLBD) are unclear. This study compares the safety and efficacy between EPLBD and endoscopic sphincterotomy (EST).

Patients and methods: Literatures were searched for randomized controlled trials in PUBMED, EMBASE, and Cochrane Library. Outcome measurements included adverse events; stone removal rate; requirement of mechanical lithotripsy.

Results: Four RCTs with a total of 596 patients were included. Three RCTs compared EPLBD versus EST alone for stone removal; one RCT compared EPLBD versus EST plus mechanical lithotripsy for stone removal. Pooled data from three RCTs showed that there was no significant difference in the adverse event of ERCP. A significantly higher cholangitis rate was seen in patients who received EST plus mechanical lithotripsy, compared to those treated with EPLBD (13.3% versus 0.0, P = 0.026). No statistical difference was found between EPLBD and EST for stone removal rate. Significant differences in requirement of mechanical lithotripsy were seen with removal of large stones (>15 mm), with EPLBD reducing the use of mechanical lithotripsy (RR: 0.73; 95% CI: 0.54-0.99).

Conclusions: EPLBD and EST have similar efficacy and safety for bile duct stones clearance. With larger stones, EPLBD can reduce requirement of mechanical lithotripsy.

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Related in: MedlinePlus

(a) Risk of bias graph. (b) Risk of bias summary.
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fig2: (a) Risk of bias graph. (b) Risk of bias summary.

Mentions: Among these 4 RCTs, no study reported the use of blinding. All but one presented description of random sequence generation and allocation concealment. Two of the included studies had low risk of bias for incomplete data and one for selective reporting (Figure 2).


Endoscopic sphincterotomy with large balloon dilation versus endoscopic sphincterotomy for bile duct stones: a systematic review and meta-analysis.

Xu L, Kyaw MH, Tse YK, Lau JY - Biomed Res Int (2015)

(a) Risk of bias graph. (b) Risk of bias summary.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4338384&req=5

fig2: (a) Risk of bias graph. (b) Risk of bias summary.
Mentions: Among these 4 RCTs, no study reported the use of blinding. All but one presented description of random sequence generation and allocation concealment. Two of the included studies had low risk of bias for incomplete data and one for selective reporting (Figure 2).

Bottom Line: No statistical difference was found between EPLBD and EST for stone removal rate.EPLBD and EST have similar efficacy and safety for bile duct stones clearance.With larger stones, EPLBD can reduce requirement of mechanical lithotripsy.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Ningbo No. 1 Hospital, Ningbo 315010, China.

ABSTRACT

Unlabelled: The safety and efficacy of endoscopic sphincterotomy with large balloon dilation (EPLBD) are unclear. This study compares the safety and efficacy between EPLBD and endoscopic sphincterotomy (EST).

Patients and methods: Literatures were searched for randomized controlled trials in PUBMED, EMBASE, and Cochrane Library. Outcome measurements included adverse events; stone removal rate; requirement of mechanical lithotripsy.

Results: Four RCTs with a total of 596 patients were included. Three RCTs compared EPLBD versus EST alone for stone removal; one RCT compared EPLBD versus EST plus mechanical lithotripsy for stone removal. Pooled data from three RCTs showed that there was no significant difference in the adverse event of ERCP. A significantly higher cholangitis rate was seen in patients who received EST plus mechanical lithotripsy, compared to those treated with EPLBD (13.3% versus 0.0, P = 0.026). No statistical difference was found between EPLBD and EST for stone removal rate. Significant differences in requirement of mechanical lithotripsy were seen with removal of large stones (>15 mm), with EPLBD reducing the use of mechanical lithotripsy (RR: 0.73; 95% CI: 0.54-0.99).

Conclusions: EPLBD and EST have similar efficacy and safety for bile duct stones clearance. With larger stones, EPLBD can reduce requirement of mechanical lithotripsy.

Show MeSH
Related in: MedlinePlus