Comparative efficacy of balloon dilatation duration on patients with choledocholithiasis: a Bayesian network meta-analysis and systematic review.

OBJECTIVE

To evaluate the application effects of different balloon dilation durations in endoscopic papillary balloon dilation (EPBD) and small endoscopic sphincterotomy with balloon dilation (ESBD) for biliary duct calculi by network meta-analysis and find the most appropriate dilation durations for both.

METHODS

PubMed, Web of Science, Cochrane Library, Embase, and other databases were searched for relevant randomized controlled trials (RCTs) published up to August 2024. Data were analyzed using R (V.4.2.3) and Stata (V.17.0).

RESULTS

A total of 12 RCTs were included, which involved 3284 patients and two treatment methods for common bile duct stones, namely ESBD and EPBD. There are ten balloon dilation durations in total. Among them, there are six balloon dilation durations (0 s, 5 s, 30 s, 60 s, 180 s, 300 s) in the ESBD group and four balloon dilation durations (20 s, 60 s, 180 s, 300 s) in the EPBD group. The network meta-analysis showed no statistical difference among different balloon dilation durations in the ESBD group. In EPBD, the 180 s group had a lower incidence of post-ERCP pancreatitis than the 20 s (OR = 0.00, 95% CI = 0.00-0.11), 60 s (OR = 0.00, 95% CI = 0.00-0.06), and 300 s (OR = 0.00, 95% CI = 0.00-0.29) groups. Regarding the success rate of stone removal in EPBD, compared with the 180 s group, the success rate of stone removal in the 20 s (OR = 0.00, 95% CI = 0.00-0.60), 60 s (OR = 0.00, 95% CI = 0.00-0.28), and 300 s (OR = 0.00, 95% CI = 0.00-0.20) groups was significantly lower. The results of the surface under the cumulative ranking curve showed that 180 s was the optimal balloon dilation duration, both in ESBD and EPBD.

CONCLUSIONS

The results of network meta-analysis show that the optimal balloon dilation duration in ESBD and EPBD may be 180 s. Further direct comparison studies and longer-term follow-up are needed.