| Background:With the development of endoscopic technology,the operative methods related to endoscopic retrograde cholangiopancreatography are gradually applied to the treatment of giant bile duct stones,including endoscopic sphincterotomy and endoscopic papillary balloon dilation and a combination of both.Objectives:To evaluate the clinical effect of endoscopic sphincterotomy plus balloon dilation(ESBD)versus sphincterotomy(EST)alone for large common bile duct(CBD)stones by Meta-analysis.Methods:Pubmed,Cochrane Central,Embase,Chinese Scientific Journa I Full—Text Database and Wanfang were searched up to 8 July 2019 for literature that compared ESBD with EST for the removal of LCBD stones.Relevant data were extracted and Meta-analysis was carried out with Review manager 5.3 software.Results:A total of 13 studies with 2076 patients were included,including 1050 cases in the ESBD group and 1026 cases in the EST group.The Meta-analysis showed that were statistically significant differences between ESBD group and EST group in the total stone removal rate across all endoscopic retrograde cholangiopancreatography(ERCP)sessions(95.6% vs 93.4%,OR=1.53,95%CI=1.03～2.29,P=0.04),the crude rate of stone removal during the first ERCP session(87.8% vs 79.7%,OR=1.77,95%CI=1.06～2.93,P=0.03),mechanical lithotripsy use(14.4% vs 32.7%,OR=0.40,95%CI=0.25～0.63,P<0.001),significant bleeding(1.0% vs 4.1%,OR=0.23,95%CI=0.11～0.50,P<0.001),cholangitis(1.4% vs 4.4%,OR=0.31,95%CI=0.12～0.78,P=0.01),total postoperative complications(6.2% vs 9.9%,OR=0.59,95%CI=0.42～0.84,P=0.003),operating time(MD=-8.89,95%CI=-17.56～-0.22,P=0.04).There were no significant differences between the two groups in the perforation(0.2% vs 1.5%,OR=0.27,95%CI=0.05～1.30,P=0.10)and pancreatitis(4.4% vs 4.2%,OR=1.03,95%CI=0.66～1.61,P=0.91).Conclusion:The efficacy and sefety of ESBD were superior to those of EST for the removal of large CBD stones. |
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