Efficacy and safety of endoscopic papillary large balloon dilation alone versus endoscopic sphincterotomy combined with large balloon dilation in treatment of large common bile duct stones: A Meta-analysis / 临床肝胆病杂志

ABSTRACT

ObjectiveTo systematically review the efficacy and safety of endoscopic papillary large balloon dilation (EPLBD) versus endoscopic sphincterotomy combined with large balloon dilation (ESBD) in the treatment of large common bile duct stones (≥10 mm). MethodsPubmed, Embase, Cochrane Library, CNKI, Wanfang Data, and VIP were searched for related articles published up to March 2020. Two reviewers independently performed article screening, data extraction, and quality assessment, and RevMan 5.3 software was used for statistical analysis. ResultsA total of 11 studies (6 randomized controlled trials and 5 non-randomized controlled trials) were included, with 1282 patients in total. The meta-analysis showed that in the 6 randomized controlled trials, there were no significant differences between the EPLBD group and the ESBD group in initial stone clearance rate (odds ratio ［OR］=0.71, 95% confidence interval ［CI］ 0.45-1.12, P=0.14), overall stone clearance rate (OR=1.39, 95%CI 0.65-2.96, P=0.39), rate of use of mechanical lithotripsy (OR=1.19, 95%CI 0.75-1.89, P=0.46), and incidence rate of early complications (OR=1.10, 95%CI 0.60-2.03, P=075); in the 5 non-randomized controlled trials, there were no significant differences between the EPLBD group and the ESBD group in initial stone clearance rate (OR=0.64, 95%CI 0.35-1.15, P=0.13), overall stone clearance rate (OR=0.46, 95%CI 0.19-112, P=009), and incidence rate of early complications (OR=1.20, 95%CI 0.65-2.21, P=0.56), but the EPLBD group had a significantly higher rate of use of mechanical lithotripsy than the ESBD group (OR=1.96, 95%CI 1.26-3.05, P=0.003). ConclusionEPLBD and ESBD have similar efficacy and safety in the treatment of large common bile duct stones, while EPLBD may increase the risk of the use of mechanical lithotripsy. More high-quality randomized controlled trials are needed to confirm this conclusion.