Xiao-Ming Yang, Bing Hu, Department of Endoscopy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
World J Gastroenterol. 2013 Dec 28;19(48):9453-60. doi: 10.3748/wjg.v19.i48.9453.
To perform a meta-analysis of large-balloon dilation (LBD) plus endoscopic sphincterotomy (EST) vs EST alone for removal of bile duct stones.
Databases including PubMed, EMBASE, the Cochrane Library, the Science Citation Index, and important meeting abstracts were searched and evaluated by two reviewers independently. The main outcome measures included: complete stone removal, stone removal in the first session, use of mechanical lithotripsy, procedure time, and procedure-related complications. A fixed-effects model weighted by the Mantel-Haenszel method was used for pooling the odds ratio (OR) when heterogeneity was not significant among the studies. When a Q test or I² statistic indicated substantial heterogeneity, a random-effects model weighted by the DerSimonian-Laird method was used.
Six randomized controlled trials involving 835 patients were analyzed. There was no significant heterogeneity for most results; we analyzed these using a fixed-effects model. Meta-analysis showed EST plus LBD caused fewer overall complications than EST alone (OR = 0.53, 95%CI: 0.33-0.85, P = 0.008); subcategory analysis indicated a significantly lower risk of perforation in the EST plus LBD group (Peto OR = 0.14, 95%CI: 0.20-0.98, P = 0.05). Use of mechanical lithotripsy in the EST plus LBD group decreased significantly (OR = 0.26, 95%CI: 0.08-0.82, P = 0.02), especially in patients with a stone size larger than 15 mm (OR = 0.15, 95%CI: 0.03-0.68, P = 0.01). There were no significant differences between the two groups regarding complete stone removal, stone removal in the first session, post-endoscopic retrograde cholangiopancreatography pancreatitis, bleeding, infection of biliary tract, and procedure time.
EST plus LBD is an effective approach for the removal of large bile duct stones, causing fewer complications than EST alone.
对大球囊扩张（LBD）联合内镜下括约肌切开术（EST）与单纯 EST 治疗胆管结石进行荟萃分析。
检索并评估了包括 PubMed、EMBASE、Cochrane 图书馆、科学引文索引和重要会议摘要在内的数据库。主要观察指标包括：完全取石、首次取石、机械碎石使用率、手术时间和手术相关并发症。当研究之间无显著异质性时，采用 Mantel-Haenszel 法加权固定效应模型进行汇总优势比（OR）。当 Q 检验或 I² 统计量表明存在显著异质性时，采用 DerSimonian-Laird 法加权随机效应模型。
纳入了 6 项涉及 835 例患者的随机对照试验。大多数结果均无显著异质性，我们采用固定效应模型进行分析。荟萃分析显示，LBD 联合 EST 治疗后总体并发症发生率低于 EST 治疗（OR=0.53，95%CI：0.33-0.85，P=0.008）；亚组分析表明，LBD 联合 EST 治疗组穿孔风险显著降低（Peto OR=0.14，95%CI：0.20-0.98，P=0.05）。LBD 联合 EST 治疗组机械碎石使用率显著降低（OR=0.26，95%CI：0.08-0.82，P=0.02），尤其是结石直径大于 15 mm 的患者（OR=0.15，95%CI：0.03-0.68，P=0.01）。两组患者在完全取石、首次取石、内镜逆行胰胆管造影术后胰腺炎、出血、胆道感染和手术时间方面均无显著差异。
LBD 联合 EST 是一种治疗胆管大结石的有效方法，与单纯 EST 治疗相比，并发症发生率更低。
