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Effects Comparison between Endoscopic Papillary Large Balloon Dilatation and Endoscopic Sphincterotomy for Common Bile Duct Stone Removal.

Guo Y, Li C, Lei S, Zhi F - Gastroenterol Res Pract (2015)

Bottom Line: Endoscopic sphincterotomy (EST) is a treatment of choice for stone extraction and is now most frequently used.The study was to compare the efficacy of endoscopic papillary large balloon dilatation (EPLBD) and endoscopic sphincterotomy (EST) for common bile duct stone removal.EPLBD showed better efficacy in certain conditions compared to EST, however with shortcomings, such as more duration, higher mechanical lithotripsy using rate, more serious overall complications rate, and bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

ABSTRACT
Endoscopic sphincterotomy (EST) is a treatment of choice for stone extraction and is now most frequently used. The study was to compare the efficacy of endoscopic papillary large balloon dilatation (EPLBD) and endoscopic sphincterotomy (EST) for common bile duct stone removal. Trials comparing the effects between EPLBD and EST treatment were searched according to the study protocol. Overall stone removal rate, complete removal rate in 1st session, treatment duration, mechanical lithotripsy using rate, and overall complication rate were compared using risk ratio (RR) and mean difference (MD) and their 95% confidence interval (CI) via RevMan 5.2 software. For overall stone removal rate, two therapies showed similar effect, but EPLBD showed better overall stone removal rate for stone >10 mm in diameter. For complete stone removal rate in 1st session, no difference was found, even for those with stone >10 mm in diameter; EPLBD showed longer treatment duration, higher mechanical lithotripsy using rate obvious overall complications rate, and more serious bleeding, whereas there were no significant differences for perforation, hyperamylasemia, pancreatitis, and cholecystitis/cholangitis. EPLBD showed better efficacy in certain conditions compared to EST, however with shortcomings, such as more duration, higher mechanical lithotripsy using rate, more serious overall complications rate, and bleeding.

No MeSH data available.


Related in: MedlinePlus

Rate ratio for complete stone removal rate in 1st session of EPLBD and EST treatment (a) and complete stone removal rate in 1st session for stone >10 mm in diameter (b).
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fig2: Rate ratio for complete stone removal rate in 1st session of EPLBD and EST treatment (a) and complete stone removal rate in 1st session for stone >10 mm in diameter (b).

Mentions: The rate ratios for overall stone removal rate for patients taking EPLBD therapies were similar to that of those taking EST therapies (RR: 1.01, 95% CI: 0.99–1.03; P = 0.35) (Figure 1(a)), but, for the patient with stone >10 mm in diameter, the rate ratios for overall stone removal rate of EPLBD were higher than those of EST (RR: 1.05, 95% CI: 1.02–1.09, P < 0.05) (Figure 1(b)). The result showed that EPLBD had better efficacy than EST method for stones larger than 10 mm in terms of overall removal rate. The rate ratio for complete stone removal rate in 1st session of EPLBD was similar to that of EST (RR: 1.07, 95% CI: 0.98–1.16, P = 0.11) (Figure 2(a)), and the rate ratio for complete stone >10 mm in diameter removal rate in 1st session for EPLBD and EST was also similar (RR: 1.11, 95% CI: 0.99–1.24, P = 0.08) (Figure 2(b)). Thus, there was no significant difference between the two kinds of treatment in terms of complete stone removal rate in 1st session. In this meta-analysis for complete stone >10 mm in diameter removal rate in 1st session, there was apparent heterogeneity (P = 0.01, I2 = 64%), so random effect model was used. What is more, for the other outcomes, fixed effect model was used for there was no apparent heterogeneity.


Effects Comparison between Endoscopic Papillary Large Balloon Dilatation and Endoscopic Sphincterotomy for Common Bile Duct Stone Removal.

Guo Y, Li C, Lei S, Zhi F - Gastroenterol Res Pract (2015)

Rate ratio for complete stone removal rate in 1st session of EPLBD and EST treatment (a) and complete stone removal rate in 1st session for stone >10 mm in diameter (b).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4553337&req=5

fig2: Rate ratio for complete stone removal rate in 1st session of EPLBD and EST treatment (a) and complete stone removal rate in 1st session for stone >10 mm in diameter (b).
Mentions: The rate ratios for overall stone removal rate for patients taking EPLBD therapies were similar to that of those taking EST therapies (RR: 1.01, 95% CI: 0.99–1.03; P = 0.35) (Figure 1(a)), but, for the patient with stone >10 mm in diameter, the rate ratios for overall stone removal rate of EPLBD were higher than those of EST (RR: 1.05, 95% CI: 1.02–1.09, P < 0.05) (Figure 1(b)). The result showed that EPLBD had better efficacy than EST method for stones larger than 10 mm in terms of overall removal rate. The rate ratio for complete stone removal rate in 1st session of EPLBD was similar to that of EST (RR: 1.07, 95% CI: 0.98–1.16, P = 0.11) (Figure 2(a)), and the rate ratio for complete stone >10 mm in diameter removal rate in 1st session for EPLBD and EST was also similar (RR: 1.11, 95% CI: 0.99–1.24, P = 0.08) (Figure 2(b)). Thus, there was no significant difference between the two kinds of treatment in terms of complete stone removal rate in 1st session. In this meta-analysis for complete stone >10 mm in diameter removal rate in 1st session, there was apparent heterogeneity (P = 0.01, I2 = 64%), so random effect model was used. What is more, for the other outcomes, fixed effect model was used for there was no apparent heterogeneity.

Bottom Line: Endoscopic sphincterotomy (EST) is a treatment of choice for stone extraction and is now most frequently used.The study was to compare the efficacy of endoscopic papillary large balloon dilatation (EPLBD) and endoscopic sphincterotomy (EST) for common bile duct stone removal.EPLBD showed better efficacy in certain conditions compared to EST, however with shortcomings, such as more duration, higher mechanical lithotripsy using rate, more serious overall complications rate, and bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

ABSTRACT
Endoscopic sphincterotomy (EST) is a treatment of choice for stone extraction and is now most frequently used. The study was to compare the efficacy of endoscopic papillary large balloon dilatation (EPLBD) and endoscopic sphincterotomy (EST) for common bile duct stone removal. Trials comparing the effects between EPLBD and EST treatment were searched according to the study protocol. Overall stone removal rate, complete removal rate in 1st session, treatment duration, mechanical lithotripsy using rate, and overall complication rate were compared using risk ratio (RR) and mean difference (MD) and their 95% confidence interval (CI) via RevMan 5.2 software. For overall stone removal rate, two therapies showed similar effect, but EPLBD showed better overall stone removal rate for stone >10 mm in diameter. For complete stone removal rate in 1st session, no difference was found, even for those with stone >10 mm in diameter; EPLBD showed longer treatment duration, higher mechanical lithotripsy using rate obvious overall complications rate, and more serious bleeding, whereas there were no significant differences for perforation, hyperamylasemia, pancreatitis, and cholecystitis/cholangitis. EPLBD showed better efficacy in certain conditions compared to EST, however with shortcomings, such as more duration, higher mechanical lithotripsy using rate, more serious overall complications rate, and bleeding.

No MeSH data available.


Related in: MedlinePlus