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Endoscopic Balloon Sphincter Dilation (sphincteroplasty) Versus Sphincterotomy For Common Bile Duct Stones.
B. Weinberg, Waleed Shindy, S. Lo
Published 2006 · Medicine
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BACKGROUND Endoscopic balloon dilation was introduced as an alternative to endoscopic sphincterotomy to preserve the sphincter of Oddi and avoid undesirable effects due to an incompetent sphincter. Endoscopic balloon dilation has been largely abandoned by USA endoscopists due to increased risks of pancreatitis noted in one multicentre trial, but is still practiced in parts of Asia and Europe. OBJECTIVES To assess the beneficial and harmful effects of endoscopic balloon dilation versus endoscopic sphincterotomy in the management of common bile duct stones. SEARCH STRATEGY We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, and EMBASE until January 2004. We hand searched Gastrointestinal Endoscopy (1983-2002), read through bibliographies of all included randomised clinical trials, and contacted all primary authors regarding missed randomised trials. SELECTION CRITERIA Randomised clinical trials comparing endoscopic balloon dilation versus endoscopic sphincterotomy in removal of common bile duct stones irrespective of publication status, language, or blinding. DATA COLLECTION AND ANALYSIS Data collection was done by two independent authors for decisions on study inclusion, data abstraction, and quality assessment. When there was a non-resolvable discrepancy, the third author made the final decision. Analysis was run with RevMan Analysis. MAIN RESULTS Fifteen randomised trials met our inclusion criteria (1768 participants). Less than half of the trials reported adequate methods of randomisation and only two trials used blinded outcome assessment. Endoscopic balloon dilation is statistically less successful for stone removal (relative risk (RR) 0.90, 95% confidence interval (CI) 0.84 to 0.97), requires higher rates of mechanical lithotripsy (RR 1.34, 95% CI 1.08 to 1.66), and carries a higher risk of pancreatitis (RR 1.96, 95% CI 1.34 to 2.89). Conversely, endoscopic balloon dilation has statistically significant lower rates of bleeding. When a fixed-effect model is applied endoscopic balloon dilation leads to significantly less short-term infection and long-term infection. There was no statistically significant difference with regards to mortality, perforation, or total short-term complications. AUTHORS' CONCLUSIONS Endoscopic balloon dilation is slightly less successful than endoscopic sphincterotomy in stone extraction and more risky regarding pancreatitis. However, endoscopic balloon dilation seems to have a clinical role in patients who have coagulopathy, who are at risk for infection, and possibly in those who are older.
This paper references
Recurrent cholangitis after biliary surgery.
L. D. Gol'dman (1983)
Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones.
J. Disario (2004)
Choledocholithiasis in cirrhotic patients: is endoscopic sphincterotomy the safest choice?
V. Moreira (1991)
Endoscopic balloon dilation compared to sphincterotomy (EDES) for extraction of bile duct stones: Preliminary results
J. Disario (1997)
Endoscopic sphincterotomy vs. endoscopic papillary balloon dilation for choledocholithiasis in patients with liver cirrhosis and coagulopathy.
D. Park (2004)
Removal of stones from the bile duct at ERCP without sphincterotomy.
G. May (1993)
Complications of endoscopic biliary sphincterotomy.
M. Freeman (1996)
Endoscopic sphincteroplasty: a novel and safe alternative to papillotomy in the management of bile duct stones.
P. Mac Mathúna (1994)
Follow-up 6 to 11 years after duodenoscopic sphincterotomy for stones in patients with prior cholecystectomy.
R. Hawes (1990)
Reported Methodologic Quality and Discrepancies between Large and Small Randomized Trials in Meta-Analyses
L. L. Kjaergard (2001)
Papillary dilation vs sphincterotomy in endoscopic removal of bile duct stones a randomized trial with manometric function
Atsushi Minami (2005)
Comparing the treatment outcomes of endoscopic papillary dilation and endoscopic sphincterotomy for removal of bile duct stones
Y. Ochi (1999)
Endoscopic papillary balloon dilation and endoscopic sphincterotomy for bile duct stones: long-term outcomes in a prospective randomized controlled trial.
S. Tanaka (2004)
[Endoscopic sphincteroclasy for choledocholithiasis of the principal bile duct. Short-term results and follow-up].
E. Kalinsky (1999)
Endoscopic papillary balloon dilation for treatment of common bile duct stones.
H. Watanabe (2004)
B. P. Colcock (1958)
Randomised trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bileduct stones
J. Bergman (1997)
ERCP and biliary endoscopic sphincterotomy-induced pancreatitis.
K. Gottlieb (1998)
Changes in biliary bacteria after endoscopic cholangiography and sphincterotomy.
J. A. Sand (1992)
Can endoscopic papillary balloon dilation really preserve sphincter of Oddi function?
I. Yasuda (2001)
4638 Endoscopic papillary balloon dilation in cirrhotic patients for the management of common bile duct stones.
Y. Komatsu (2000)
Biliary sequelae of endoscopic sphincterotomy.
C. Greenfield (1985)
Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age.
J. Bergman (1996)
Stent placement in the pancreatic duct prevents pancreatitis after endoscopic sphincter dilation for removal of bile duct stones.
T. Aizawa (2001)
Does endoscopic sphincterotomy destroy the function of Oddi's sphincter?
P. M. Heinerman (1994)
Endoscopic Balloon Dilation of the Biliary Sphincter Compared to Endoscopic Biliary Sphincterotomy for Removal of Common Bile Duct Stones During ERCP: A Metaanalysis of Randomized, Controlled Trials
T. Baron (2004)
Endoscopic balloon sphincteroplasty (papillary dilation) for bile duct stones: efficacy, safety, and follow-up in 100 patients.
P. M. Mathuna (1995)
Removal of common bile duct stones by the combination of percutaneous balloon dilatation and extracorporeal shock-wave lithotripsy.
J. Groen (1989)
Comparing the treatment outcomes of endoscopic papillary dilation and endoscopic sphincterotomy for removal of bile duct stones.
Bhasin Dk (1999)
Endoscopic sphincterotomy complications and their management: an attempt at consensus.
P. Cotton (1991)
Endoscopic dilatation of the biliary sphincter for removal of bile duct stones: an overview of current indications and limitations.
J. Bergman (1998)
What are really the true late complications of endoscopic biliary sphincterotomy?
S. Sheth (2002)
Endoscopic papillary balloon dilation for the management of common bile duct stones: experience of 226 cases.
Y. Komatsu (1998)
Effects of sphincteroplasty and endoscopic sphincterotomy on the bacteriologic characteristics of the common bile duct.
J. Gregg (1985)
A randomized trial of endoscopic balloon dilation and endoscopic sphincterotomy for removal of bile duct stones in patients with a prior Billroth II gastrectomy.
J. Bergman (2001)
Treatment of Choledocholithiasis in Patients with Liver Cirrhosis Surgical Treatment or Endoscopic Sphincterotomy?
M. Sugiyama (1993)
Overexpression of Cholecystokinin-B/ Gastrin Receptor Gene in the Stomach of Naturally Occurring Cholecystokinin-A Receptor Gene Knockout Rats
K. Miyasaka (1998)
Endoskopische Sphinkterotomie der Papilla Vateri und Steinextraktion aus dem Ductus choledochus
M. Classen (1974)
Bacterial growth in the duodenum and in the bile of patients with gallstone disease treated with endoscopic papillotomy (EPT).
V. Skar (1986)
Endoscopic papillary balloon dilation in cirrhotic patients: removal of common bile duct stones without sphincterotomy.
T. Kawabe (1996)
Endoscopic balloon dilatation is a safe method in the management of common bile duct stones.
C. Lin (2004)
Endoscopic papillary balloon dilation vs. sphincterotomy for removal of common bile duct stones: a prospective randomized pilot study.
J. C. Arnold (2001)
Nifedipine for prevention of post-ERCP pancreatitis: a prospective, double-blind randomized study.
F. Prat (2002)
Assessment of residual bile duct stones with use of intraductal US during endoscopic balloon sphincteroplasty: comparison with balloon cholangiography.
A. Ohashi (1999)
Changes in substance P-immunoreactive innervation of human colon associated with ulcerative colitis
U. Keränen (2005)
Biliary sphincter balloon dilation; who, when and how?
K. Huibregtse (1999)
Risk factors predictive of late complications after endoscopic sphincterotomy for bile duct stones : long-term (more than 10 years) follow-up study
M. Sugiyama (2002)
Endoscopic papillary balloon dilatation for common bile duct stones: efficacy of combination with extra corporeal Shockwave lithotripsy for large stones
I. Yasuda (1998)
Epinephrine irrigation for the prevention of pancreatic damage after endoscopic balloon sphincteroplasty
A. Ohashi (2001)
Dilatation endoscopique par ballon de la papille en vue de l’extraction de calculs biliaires: description de la technique endoscopique et revue de la littérature
J. Bergman (2008)
Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials.
K. Schulz (1995)
Endoscopic papillary balloon dilation for the management of common bile duct stones: Experience of 207 cases including high risk patients
Y. Komatsu (1997)
Long-term consequence of endoscopic sphincterotomy for bile duct stones.
M. Tanaka (1998)
Endoscopic papillary balloon dilation (EPBD) may preserve sphincter of oddi (SO) function
H. Sato (1997)
Follow‐up of more than 10 years after endoscopic sphincterotomy for choledocholithiasis in young patients
M. Sugiyama (1998)
Effect of endoscopic balloon sphincteroplasty (EBS) on sphincter of Oddi-evaluation from the view point of endoscopic manometry
H. Sato (1996)
Pathogenesis of calcium bilirubinate gallstone: role of E. coli, beta-glucuronidase and coagulation by inorganic ions, polyelectrolytes and agitation.
T. Maki (1966)
Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age. Gastrointestinal Endoscopy 1996;44:643–9
JJ Bergman 1996 Bergman (1996)
Endoscopic sphincterotomy and endoscopic papillary balloon dilatation for bile duct stones: a prospective randomized controlled multicenter trial
N. Fujita (2003)
Influence of bile duct diameter on the therapeutic quality of endoscopic balloon sphincteroplasty.
A. Ohashi (1999)
The role of endoscopic balloon sphincteroplasty in patients with gallbladder and bile duct stones.
K. Ido (1997)
Endoscopic sphincterotomy of the papilla of Vater.
A. Belsito (1983)
Endoscopic balloon sphincteroplasty (EBS) reduces the need for papillotomy: 2 year follow-up in 100 patients
P. M. Mathuna (1995)
Endoscopic balloon dilation vs. sphincterotomy (EDES) bile duct stone removal
Endoscopic papillary dilation (EPD) for the treatment of common bile duct stones and papillary stenosis.
M. Staritz (1983)
Endoscopic sphincterotomy (ES) vs endoscopic balloon dilatation (EBD) for bile duct stones (BDS). Results in 28 patients (PTS) under 56 years of age
V. Pugliese (1997)
What is an appropriate indication for endoscopic papillary balloon dilation?
M. Natsui (2002)
Long-term observations on morphological changes of choledochal epithelium after choledochoenterostomy in rats
K. Kurumado (2005)
Effect of endoscopic papillary balloon dilation for the management of common bile duct stones in the elderly
F. Iwata (1998)
Endoscopic balloon dilatation versus endoscopic sphincterotomy for the removal of bile duct stones: a prospective randomised trial
P. Vlavianos (2003)
Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?
D. Moher (1998)
Effect of perioperative somatostatin administration of sphincteroplasty-induced increase of amylase.
L. Roncoroni (1986)
This paper is referenced by
Endoscopic Management of Biliary Obstruction
J. Tabibian (2014)
Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - updated June 2014.
J. Dumonceau (2014)
The role of endoscopy in the management of choledocholithiasis.
J. Maple (2011)
Gestione endoscopica della calcolosi della via biliare
V. Cennamo (2012)
Evidence-based clinical practice guidelines for cholelithiasis 2016
S. Tazuma (2016)
Endoluminal Therapy for Choledocholithiasis and Cholangitis
Aditya Gutta (2019)
Endoscopic Balloon Dilatation vs. Sphincterotomy in Cases of Calcular Obstructive Jaundice during Endoscopic Retrograde Cholangio Pancreatography
Mohamed Abdel Rasheed (2017)
International consensus guidelines for endoscopic papillary large-balloon dilation.
T. H. Kim (2016)
The role of ERCP in benign diseases of the biliary tract.
K. Chathadi (2015)
Decision and Simulation Modeling in Systematic Reviews
K. Kuntz (2013)
Temporary Trans-gastric Stent Deployment Over a 20 French Gastrostomy for Single-Stage Endoscopic Retrograde Cholangiopancreatography After Gastric Bypass
G. Donatelli (2020)
Risk factors for recurrent symptomatic pigmented biliary stones after percutaneous transhepatic biliary extraction.
D. Kim (2010)
Endoscopic retrograde cholangiopancreatography (ERCP) for dificult common bile duct stones
E. L. Artifon (2011)
Bleeding risk in endoscopic retrograde cholangiopancreatography. Impact of the use of antithrombotic drugs.
Fernando Alberca de las Parras (2017)
Endoscopic papillary large balloon dilation vs endoscopic sphincterotomy for retrieval of common bile duct stones: a meta-analysis.
P. Jin (2014)
Late Complications After Endoscopic Sphincterotomy
Melissa Oliveira-Cunha (2016)
Cálculo difícil en CPRE Endoscopic retrograde cholangiopancreatography (ERCP) for dificult common bile duct stones
E. L. A. Artifon (2011)
stoneson the management of common bile duct
M. Lombard (2008)
A comparative study of one minute versus five seconds endoscopic biliary balloon dilation after small sphincterotomy in choleducolithiasis
A. Shavakhi (2015)
Endoscopic papillary large balloon dilation for the removal of bile duct stones.
J. Kim (2013)
Updated guideline on the management of common bile duct stones (CBDS)
E. Williams (2017)
Endoscopic papillary balloon dilation for difficult common bile duct stones: Our experience.
M. Zippi (2013)
Genetics and treatment of bile duct stones: new approaches
M. Krawczyk (2013)
Large Size Balloon Dilation of the Ampulla After Biliary Sphincterotomy Can Facilitate Endoscopic Extraction of Difficult Bile Duct Stones
P. Draganov (2009)
Endoscopic extraction of large common bile duct stones: A review article.
G. Stefanidis (2012)
Is the Balloon Dilation Duration in Endoscopic Papillary Balloon Dilation (EPBD) Related to the Occurrence of Post-EPBD Pancreatitis?
D. Kim (2015)
Endoscopic Management of Complex Biliary Stone Disease.
Prashant Kedia (2019)
Is endoscopic papillary balloon dilatation really a risk factor for post-ERCP pancreatitis?
T. Fujisawa (2016)
Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis using pancreatic stents: A review of efficacy, diameter and length
Mitsuru Sugimoto (2019)
Sphincterotomy with Large Balloon to Extract Common Bile Duct Stones: Sometimes It Is Better to Get an “Incomplete”
F. Caillol (2015)
Endoscopic papillary large balloon dilation for large common bile duct stones.
R. Attam (2009)
Patient-reported outcome measures after endoscopic retrograde cholangiopancreatography: a prospective, multicentre study
T. Glomsaker (2013)See more