Endoscopic sphincterotomy vs papillary large balloon dilation vs combination modalities for large common bile duct stones: a network meta-analysis
Background and study aims The optimal technique for removal of large common bile duct (CBD) stones (≥ 10 mm) during endoscopic retrograde cholangiopancreatography (ERCP) remains unclear. We aimed to perform a comparative analysis between different endoscopic techniques. Methods Adhering t...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2022-12-01
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| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/a-1958-2348 |
| _version_ | 1828117232385785856 |
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| author | Muhammad Aziz Zubair Khan Hossein Haghbin Faisal Kamal Sachit Sharma Wade Lee-Smith Asad Pervez Yaseen Alastal Ali Nawras Nirav Thosani |
| author_facet | Muhammad Aziz Zubair Khan Hossein Haghbin Faisal Kamal Sachit Sharma Wade Lee-Smith Asad Pervez Yaseen Alastal Ali Nawras Nirav Thosani |
| author_sort | Muhammad Aziz |
| collection | DOAJ |
| description | Background and study aims The optimal technique for removal of large common bile duct (CBD) stones (≥ 10 mm) during endoscopic retrograde cholangiopancreatography (ERCP) remains unclear. We aimed to perform a comparative analysis between different endoscopic techniques.
Methods Adhering to PRISMA guidelines, a stringent search of the following databases through January 12, 2021, were undertaken: PubMed/Medline, Embase, Web of Science, and Cochrane. Randomized controlled trials comparing the following endoscopic techniques were included: (1) Endoscopic sphincterotomy (EST); (2) Endoscopic papillary large balloon dilation (EPLBD); and (3) EST plus large balloon dilation (ESLBD). Stone clearance rate (SCR) on index ERCP was the primary outcome/endpoint. Need for mechanical lithotripsy (ML) and adverse events were also evaluated as secondary endpoint. Random effects model and frequentist approach were used for statistical analysis.
Results A total of 16 studies with 2545 patients (1009 in EST group, 588 in EPLBD group, and 948 patients in ESLBD group) were included. The SCR was significantly higher in ESLBD compared to EST risk ratio [RR]: 1.11, [confidence interval] CI: 1.00–1.24). Lower need for ML was noted for ESLBD (RR: 0.48, CI: 0.31–0.74) and EPLBD (RR: 0.58, CI: 0.34–0.98) compared to EST. All other outcomes including bleeding, perforation, post-ERCP pancreatitis, stone recurrence, cholecystitis, cholangitis, and mortality did not show significant difference between the three groups. Based on network ranking, ESLBD was superior in terms of SCR as well as lower need for ML and adverse events (AEs).
Conclusions Based on network meta-analysis, ESLBD seems to be superior with higher SCR and lower need for ML and AEs for large CBD stones. |
| first_indexed | 2024-04-11T13:10:56Z |
| format | Article |
| id | doaj.art-e12b380b19eb46f88ca6b0d257f2ad71 |
| institution | Directory Open Access Journal |
| issn | 2364-3722 2196-9736 |
| language | English |
| last_indexed | 2024-04-11T13:10:56Z |
| publishDate | 2022-12-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj.art-e12b380b19eb46f88ca6b0d257f2ad712022-12-22T04:22:35ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362022-12-011012E1599E160710.1055/a-1958-2348Endoscopic sphincterotomy vs papillary large balloon dilation vs combination modalities for large common bile duct stones: a network meta-analysisMuhammad Aziz0Zubair Khan1Hossein Haghbin2Faisal Kamal3Sachit Sharma4Wade Lee-Smith5Asad Pervez6Yaseen Alastal7Ali Nawras8Nirav Thosani9Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OhioCenter for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School, Houston, TexasDivision of Gastroenterology, Ascension providence Hospital, Southfield, Michigan, United StatesDivision of Gastroenterology, University of California, San Francisco, California, United StatesDivision of Gastroenterology, Virginia Commonwealth University, Richmond, Virginia, United StatesUniversity of Toledo Libraries, University of Toledo, Toledo, Ohio, United StatesDivision of Gastroenterology, West Virginia University, Morgantown, West Virginia, United StatesDivision of Gastroenterology and Hepatology, University of Toledo, Toledo, OhioDivision of Gastroenterology and Hepatology, University of Toledo, Toledo, OhioCenter for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School, Houston, TexasBackground and study aims The optimal technique for removal of large common bile duct (CBD) stones (≥ 10 mm) during endoscopic retrograde cholangiopancreatography (ERCP) remains unclear. We aimed to perform a comparative analysis between different endoscopic techniques. Methods Adhering to PRISMA guidelines, a stringent search of the following databases through January 12, 2021, were undertaken: PubMed/Medline, Embase, Web of Science, and Cochrane. Randomized controlled trials comparing the following endoscopic techniques were included: (1) Endoscopic sphincterotomy (EST); (2) Endoscopic papillary large balloon dilation (EPLBD); and (3) EST plus large balloon dilation (ESLBD). Stone clearance rate (SCR) on index ERCP was the primary outcome/endpoint. Need for mechanical lithotripsy (ML) and adverse events were also evaluated as secondary endpoint. Random effects model and frequentist approach were used for statistical analysis. Results A total of 16 studies with 2545 patients (1009 in EST group, 588 in EPLBD group, and 948 patients in ESLBD group) were included. The SCR was significantly higher in ESLBD compared to EST risk ratio [RR]: 1.11, [confidence interval] CI: 1.00–1.24). Lower need for ML was noted for ESLBD (RR: 0.48, CI: 0.31–0.74) and EPLBD (RR: 0.58, CI: 0.34–0.98) compared to EST. All other outcomes including bleeding, perforation, post-ERCP pancreatitis, stone recurrence, cholecystitis, cholangitis, and mortality did not show significant difference between the three groups. Based on network ranking, ESLBD was superior in terms of SCR as well as lower need for ML and adverse events (AEs). Conclusions Based on network meta-analysis, ESLBD seems to be superior with higher SCR and lower need for ML and AEs for large CBD stones.http://www.thieme-connect.de/DOI/DOI?10.1055/a-1958-2348 |
| spellingShingle | Muhammad Aziz Zubair Khan Hossein Haghbin Faisal Kamal Sachit Sharma Wade Lee-Smith Asad Pervez Yaseen Alastal Ali Nawras Nirav Thosani Endoscopic sphincterotomy vs papillary large balloon dilation vs combination modalities for large common bile duct stones: a network meta-analysis Endoscopy International Open |
| title | Endoscopic sphincterotomy vs papillary large balloon dilation vs combination modalities for large common bile duct stones: a network meta-analysis |
| title_full | Endoscopic sphincterotomy vs papillary large balloon dilation vs combination modalities for large common bile duct stones: a network meta-analysis |
| title_fullStr | Endoscopic sphincterotomy vs papillary large balloon dilation vs combination modalities for large common bile duct stones: a network meta-analysis |
| title_full_unstemmed | Endoscopic sphincterotomy vs papillary large balloon dilation vs combination modalities for large common bile duct stones: a network meta-analysis |
| title_short | Endoscopic sphincterotomy vs papillary large balloon dilation vs combination modalities for large common bile duct stones: a network meta-analysis |
| title_sort | endoscopic sphincterotomy vs papillary large balloon dilation vs combination modalities for large common bile duct stones a network meta analysis |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/a-1958-2348 |
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