Jin Hong Kim, Min Jae Yang, Jae Chul Hwang, Byung Moo Yoo, Department of Gastroenterology, Ajou University School of Medicine, Suwon 443-721, South Korea.
World J Gastroenterol. 2013 Dec 14;19(46):8580-94. doi: 10.3748/wjg.v19.i46.8580.
Endoscopic papillary large balloon dilation (EPLBD) with endoscopic sphincterotomy (EST) has been widely used as the alternative to EST along with endoscopic mechanical lithotripsy (EML) for the removal of large or difficult bile duct stones. Furthermore, EPLBD without EST was recently introduced as its simplified alternative technique. Thus, we systematically searched PubMed, Medline, the Cochrane Library and EMBASE, and analyzed all gathered data of EPLBD with and without EST, respectively, by using a single standardized definition, reviewing relevant literatures, published between 2003 and June 2013, where it was performed with large-diameter balloons (12-20 mm). The outcomes, including the initial success rate, the rate of needs for EML, and the overall success rate, and adverse events were assessed in each and compared between both of two procedures: "EPLBD with EST" and "EPLBD without EST". A total of 2511 procedures from 30 published articles were included in EPLBD with EST, while a total of 413 procedures from 3 published articles were included in EPLBD without EST. In the results of outcomes, the overall success rate was 96.5% in EPLBD with EST and 97.2% in EPLBD without EST, showing no significant difference between both of them. The initial success rate (84.0% vs 76.2%, P < 0.001) and the success rate of EPLBD without EML (83.2% vs 76.7%, P = 0.001) was significantly higher, while the rate of use of EML was significantly lower (14.1% vs 21.6%, P < 0.001), in EPLBD with EST. The rate of overall adverse events, pancreatitis, bleeding, perforation, other adverse events, surgery for adverse events, and fatal adverse events were 8.3%, 2.4%, 3.6%, 0.6%, 1.7%, 0.2% and 0.2% in EPLBD with EST and 7.0%, 3.9%, 1.9%, 0.5%, 0.7%, 0% and 0% in EPLBD without EST, respectively, showing no significant difference between both of them. In conclusion, recent accumulated results of EPLBD with or even without EST suggest that it is a safe and effective procedure for the removal of large or difficult bile duct stones without any additional risk of severe adverse events, when performed under appropriate guidelines.
内镜下乳头大球囊扩张术（EPLBD）联合内镜下括约肌切开术（EST）已广泛用于替代 EST 联合内镜下机械碎石术（EML）以清除大或困难的胆管结石。此外，最近还引入了不联合 EST 的简化 EPLBD 技术。因此，我们系统地检索了 PubMed、Medline、Cochrane 图书馆和 EMBASE，并分别使用单一标准化定义，对有和无 EST 的 EPLBD 所有收集的数据进行了分析，查阅了 2003 年至 2013 年 6 月之间发表的相关文献，这些研究均使用大直径球囊（12-20mm）进行。评估了初始成功率、需要 EML 的比率以及总成功率和不良事件，并在两种操作之间进行了比较：“EPLBD 联合 EST”和“EPLBD 不联合 EST”。在 EPLBD 联合 EST 中，有 30 篇文献共 2511 例患者纳入研究，EPLBD 不联合 EST 中有 3 篇文献共 413 例患者纳入研究。在结果方面，EPLBD 联合 EST 的总成功率为 96.5%，EPLBD 不联合 EST 的总成功率为 97.2%，两者之间无显著差异。EPLBD 联合 EST 的初始成功率（84.0%比 76.2%，P <0.001）和无需 EML 的 EPLBD 成功率（83.2%比 76.7%，P = 0.001）较高，而需要 EML 的比率（14.1%比 21.6%，P <0.001）较低。EPLBD 联合 EST 的总不良事件发生率、胰腺炎、出血、穿孔、其他不良事件、针对不良事件的手术和致命不良事件发生率分别为 8.3%、2.4%、3.6%、0.6%、1.7%、0.2%和 0.2%，EPLBD 不联合 EST 的分别为 7.0%、3.9%、1.9%、0.5%、0.7%、0%和 0%，两者之间无显著差异。总之，最近有 EPLBD 联合 EST 甚至不联合 EST 的研究结果表明，在适当的指南下，当用于清除大或困难的胆管结石时，它是一种安全有效的方法，不会增加严重不良事件的风险。
