Department of General Surgery, the First Affiliated Hospital, Anhui Medical University, Hefei 230022, Anhui Province, China.
World J Gastroenterol. 2013 Jun 28;19(24):3883-91. doi: 10.3748/wjg.v19.i24.3883.
To assess endoscopic papillary balloon dilatation (EPBD) and endoscopic sphincteropapillotomy (EST) for common bile duct (CBD) stone removal using a meta-analysis.
Randomized controlled trials published from 1990 to 2012 comparing EPBD with EST for CBD stone removal were evaluated. This meta-analysis was performed to estimate short-term and long-term complications of these two treatments. The fixed random effect model or random effect model was established to analysis the data. Results were obtained by analyzing the relative risk, odds ratio, and 95%CI for a given comparison using RevMan 5.1. Statistical significance was defined as P < 0.05. Risk of bias was evaluated using a funnel plot.
Of the 1975 patients analyzed, 980 of them were treated with EPBD and 995 were treated with EST. Of the patient population, patients in the EPBD group were younger (OR = -1.16, 95%CI: -1.49 to 0.84, P < 0.01). There were no significant differences in gender proportion, average size of stones, number of gallstones, previous cholecystectomy, the incidence of duodenal diverticulum, CBD diameter or the total follow-up time between EST and EPBD groups. Compared with EST, the total stone clearance in the EPBD group decreased (OR = 0.64, 95%CI: 0.42 to 0.96, P = 0.03), the use of stone extraction baskets significantly increased (OR = 1.91, 95%CI: 1.41 to 2.59, P < 0.01), and the incidence of pancreatitis significantly increased (OR = 2.79, 95%CI: 1.74 to 4.45, P < 0.0001). The incidence of bleeding (OR = 0.12, 95%CI: 0.04 to 0.34, P < 0.01) and cholecystitis (OR = 0.41, 95%CI: 0.20 to 0.84, P = 0.02) significantly decreased. The stone recurrence rate also was significantly reduced in EPBD (OR = 0.48, 95%CI: 0.26 to 0.90, P = 0.02). There were no significant differences between the two groups with the incidence of stone removal at first attempt, hours of operation, total short-term complications and infection, perforation, or acute cholangitis.
Although the incidence of pancreatitis was higher, the overall stone clearance rate and risk of bleeding was lower with EPBD compared to EST.
通过荟萃分析评估内镜下乳头气囊扩张术（EPBD）与内镜下括约肌切开术（EST）治疗胆总管（CBD）结石的效果。
评估了 1990 年至 2012 年期间发表的比较 EPBD 与 EST 治疗 CBD 结石的随机对照试验。本荟萃分析旨在评估这两种治疗方法的短期和长期并发症。使用 RevMan 5.1 分析数据，建立固定随机效应模型或随机效应模型。通过分析特定比较的相对风险、比值比和 95%CI 来获得结果。P < 0.05 为统计学显著。使用漏斗图评估偏倚风险。
在分析的 1975 名患者中，980 名患者接受 EPBD 治疗，995 名患者接受 EST 治疗。在患者人群中，EPBD 组的患者更年轻（OR = -1.16，95%CI：-1.49 至 0.84，P < 0.01）。EST 和 EPBD 组之间的性别比例、结石平均大小、胆囊结石数量、既往胆囊切除术、十二指肠憩室发生率、CBD 直径或总随访时间无显著差异。与 EST 相比，EPBD 组的总结石清除率降低（OR = 0.64，95%CI：0.42 至 0.96，P = 0.03），结石提取篮的使用显著增加（OR = 1.91，95%CI：1.41 至 2.59，P < 0.01），胰腺炎的发生率显著增加（OR = 2.79，95%CI：1.74 至 4.45，P < 0.0001）。出血（OR = 0.12，95%CI：0.04 至 0.34，P < 0.01）和胆囊炎（OR = 0.41，95%CI：0.20 至 0.84，P = 0.02）的发生率显著降低。EPBD 组的结石复发率也显著降低（OR = 0.48，95%CI：0.26 至 0.90，P = 0.02）。两组首次取石成功率、手术时间、总短期并发症和感染、穿孔或急性胆管炎的发生率均无显著差异。
尽管胰腺炎的发生率较高，但与 EST 相比，EPBD 的总体结石清除率和出血风险较低。
