不同持续时间的球囊扩张术治疗胆管结石的疗效：一项网状Meta分析。

The therapeutic effect of balloon dilatation with different duration for biliary duct calculi: A network meta-analysis.

作者信息

Yu Zhi Yuan, Liang Chen, Yang Shi Yu, Zhang Xu, Sun Yan

机构信息

Department of General Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.

Difficult and Complicated Liver Diseases and Artificial Liver Center, Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, You' an Hospital, Capital Medical University, Beijing, China.

出版信息

J Minim Access Surg. 2022 Jul-Sep;18(3):327-337. doi: 10.4103/jmas.JMAS_304_20.

DOI:10.4103/jmas.JMAS_304_20

PMID:35708376

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9306115/

Abstract

OBJECTIVE

To systematically evaluate the application effect of endoscopic papillary balloon dilatation (EPBD) with different balloon dilatation duration for biliary duct calculi, and find the most appropriate dilatation duration for EPBD using a network meta-analysis.

MATERIALS AND METHODS

PubMed, Embase and Cochrane Library databases were searched for relevant randomised controlled trials (RCTs) published up to August 2020. Node split, consistency and inconsistency models analysis were all conducted in network meta-analysis.

RESULTS

Eighteen RCTs with 2256 participants were finally analysed. EPBD was divided into four categories based on balloon dilatation duration, including EPBD (P0.5), EPBD (>0.5, ≤1), EPBD (1, ≤2) and EPBD (>2, ≤5). Compared with EPBD (>0.5, ≤1), EPBD (>2, ≤5) had a lower risk of early complications (odds ratio [OR] = 0.23, 95% credible interval [CI] = 0.05-0.96) and post-endoscopic procedure pancreatitis (PEP) (OR = 0.17, 95% CI = 0.03-0.72). Endoscopic sphincterotomy (EST) tended to have less need for mechanical lithotripsy (OR = 0.37, 95% CI = 0.16-0.88) and PEP (OR = 0.26, 95% CI = 0.08-0.71) than EPBD (>0.5, ≤1). EPBD (>2, ≤5) was the safest endoscopic procedure with respect to early complications (surface area under cumulative ranking curves [SUCRA] = 79.0) and PEP (SUCRA = 85.3). In addition, EPBD (>2, ≤5) and EST had the highest probability of being the best (SUCRA = 82.6) and the worst (SUCRA = 10.8), respectively, regarding late complications.

CONCLUSION

EPBD and EST are two methods used to treat uncomplicated choledocholithiasis (stone diameter <10 mm and stone number <3). The extension of balloon dilatation duration has no significant influence on successful stone removal in the first endoscopic session or preventing the need for mechanical lithotripsy. However, it can reduce the risk of early complications, especially PEP. What's more, EPBD seems to have less late complications compared with EST, and the effect of prolonged balloon dilatation duration on late complications still needs to be further explored. Therefore, 2-5 min is the recommended dilatation duration range for EPBD using balloon with ≤10 mm diameter. Further research based on a specific population and with a longer follow-up time are needed.

摘要

目的

系统评价不同球囊扩张持续时间的内镜乳头球囊扩张术（EPBD）治疗胆管结石的应用效果，通过网状Meta分析找出EPBD最合适的扩张持续时间。

材料与方法

检索PubMed、Embase和Cochrane图书馆数据库中截至2020年8月发表的相关随机对照试验（RCT）。在网状Meta分析中进行节点拆分、一致性和不一致性模型分析。

结果

最终分析了18项RCT，共2256名参与者。根据球囊扩张持续时间将EPBD分为四类，包括EPBD（P0.5）、EPBD（>0.5，≤1）、EPBD（1，≤2）和EPBD（>2，≤5）。与EPBD（>0.5，≤1）相比，EPBD（>2，≤5）早期并发症风险较低（比值比[OR]=0.23，95%可信区间[CI]=0.05-0.96），内镜术后胰腺炎（PEP）风险也较低（OR=0.17，95%CI=0.03-0.72）。内镜括约肌切开术（EST）与EPBD（>0.5，≤1）相比，机械碎石术需求倾向于更少（OR=0.37，95%CI=0.16-0.88），PEP风险也较低（OR=0.26，95%CI=0.08-0.71）。就早期并发症（累积排序曲线下面积[SUCRA]=79.0）和PEP（SUCRA=85.3）而言，EPBD（>2，≤5）是最安全的内镜操作。此外，就晚期并发症而言，EPBD（>2，≤5）和EST分别是最佳（SUCRA=82.6）和最差（SUCRA=10.8）的概率最高。

结论

EPBD和EST是治疗单纯胆总管结石（结石直径<10mm且结石数量<3个）的两种方法。球囊扩张持续时间的延长对首次内镜治疗时结石清除成功或避免机械碎石术需求无显著影响。然而，它可降低早期并发症风险，尤其是PEP。此外，与EST相比，EPBD似乎晚期并发症更少，球囊扩张持续时间延长对晚期并发症的影响仍需进一步探索。因此，对于直径≤10mm的球囊，推荐EPBD的扩张持续时间范围为2-5分钟。需要基于特定人群并进行更长随访时间的进一步研究。