内镜括约肌切开术联合大球囊扩张术与单纯内镜括约肌切开术治疗胆管结石的系统评价和Meta分析

Endoscopic sphincterotomy with large balloon dilation versus endoscopic sphincterotomy for bile duct stones: a systematic review and meta-analysis.

作者信息

Xu Lei, Kyaw Moe Htet, Tse Yee Kit, Lau James Yun Wong

机构信息

Department of Gastroenterology, Ningbo No. 1 Hospital, Ningbo 315010, China.

Institute of Digestive Diseases, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.

出版信息

Biomed Res Int. 2015;2015:673103. doi: 10.1155/2015/673103. Epub 2015 Feb 10.

UNLABELLED

The safety and efficacy of endoscopic sphincterotomy with large balloon dilation (EPLBD) are unclear. This study compares the safety and efficacy between EPLBD and endoscopic sphincterotomy (EST).

PATIENTS AND METHODS

Literatures were searched for randomized controlled trials in PUBMED, EMBASE, and Cochrane Library. Outcome measurements included adverse events; stone removal rate; requirement of mechanical lithotripsy.

RESULTS

Four RCTs with a total of 596 patients were included. Three RCTs compared EPLBD versus EST alone for stone removal; one RCT compared EPLBD versus EST plus mechanical lithotripsy for stone removal. Pooled data from three RCTs showed that there was no significant difference in the adverse event of ERCP. A significantly higher cholangitis rate was seen in patients who received EST plus mechanical lithotripsy, compared to those treated with EPLBD (13.3% versus 0.0, P = 0.026). No statistical difference was found between EPLBD and EST for stone removal rate. Significant differences in requirement of mechanical lithotripsy were seen with removal of large stones (>15 mm), with EPLBD reducing the use of mechanical lithotripsy (RR: 0.73; 95% CI: 0.54-0.99).

CONCLUSIONS

EPLBD and EST have similar efficacy and safety for bile duct stones clearance. With larger stones, EPLBD can reduce requirement of mechanical lithotripsy.

未标注

内镜下括约肌切开术联合大球囊扩张术（EPLBD）的安全性和有效性尚不清楚。本研究比较了EPLBD与内镜下括约肌切开术（EST）的安全性和有效性。

患者与方法

在PUBMED、EMBASE和Cochrane图书馆中检索随机对照试验的文献。观察指标包括不良事件、结石清除率、机械碎石的需求。

结果

纳入4项随机对照试验，共596例患者。3项随机对照试验比较了EPLBD与单纯EST清除结石的效果；1项随机对照试验比较了EPLBD与EST联合机械碎石清除结石的效果。三项随机对照试验的汇总数据显示，ERCP的不良事件无显著差异。与接受EPLBD治疗的患者相比，接受EST联合机械碎石治疗的患者胆管炎发生率显著更高（13.3%对0.0，P = 0.026）。EPLBD与EST在结石清除率方面无统计学差异。在清除大结石（>15mm）时，机械碎石的需求存在显著差异，EPLBD减少了机械碎石的使用（RR：0.73；95%CI：0.54 - 0.99）。