Endoscopy 2019; 51(04): S14-S15
DOI: 10.1055/s-0039-1681210
ESGE Days 2019 oral presentations
Friday, April 5, 2019 08:30 – 10:30: ERCP stones Club H
Georg Thieme Verlag KG Stuttgart · New York

IS ENDOSCOPIC BALLOON DILATION STILL ASSOCIATED WITH HIGHER RATES OF PANCREATITIS? A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS

C Ogawa Matsubayashi
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil
,
W Marques Bernardo
2   University of São Paulo, Sao Paulo, Brazil
,
A Coutinho Madruga
3   Gastrointestinal Endoscopy Unit, University of São Paulo, Sao Paulo, Brazil
,
RC Lins Mota
3   Gastrointestinal Endoscopy Unit, University of São Paulo, Sao Paulo, Brazil
,
M Oliveira de Marco
3   Gastrointestinal Endoscopy Unit, University of São Paulo, Sao Paulo, Brazil
,
D Tavares Rezende
3   Gastrointestinal Endoscopy Unit, University of São Paulo, Sao Paulo, Brazil
,
V Ottoboni Brunaldi
4   Gastrointestinal Endoscopy Unit, University of Sao Paulo, São Paulo, Brazil
,
T Prince Franzini
3   Gastrointestinal Endoscopy Unit, University of São Paulo, Sao Paulo, Brazil
,
E Guimarães Hourneaux de Moura
4   Gastrointestinal Endoscopy Unit, University of Sao Paulo, São Paulo, Brazil
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Evaluate effectiveness and safety of endoscopic balloon dilation compared with sphincterotomy or with endoscopic balloon dilation plus sphincterotomy in patients with common bile duct stones.

Methods:

We searched MEDLINE, EMBASE, CENTRAL up to September 2018 and selected only randomized controlled trials (RCTs). Two investigators independently conducted data extraction, and risk of bias. Summary effect sizes were estimated using risk difference with fixed effects model. Heterogeneity was assessed with the Higgins' test (i2). If i2> 50%, we analyzed forest plot in an an attempt to identify a study with a higher likelihood of outlier publication or we considered a random-effect model.

Results:

Twenty-five randomized controlled trials, enrolling a total of 3347 patients met our inclusion criteria.

EPBD x EST.

EPBD was associated with lower bleeding and higher pancreatitis and severe pancreatitis rates. Perforation and cholangitis incidence was similar in both groups.

We carried out subgroup analysis by stratifying the balloon size and observed that higher incidences of PEP was seen in the studies which performed dilation with balloons smaller than 10 mm (RD = 0.05; IC [0.03, 0.08]; i2 = 52%; P < 0.0001) than ballons≥10 mm (RD =-0.01; IC [-0.04, 0.02]; i2 = 31%; P = 0.52).

EPLBD x EPLBD+EST.

In this analysis 456 patients were enrolled and almost none heterogeneity was observed. Both techniques had almost the same safety and achieved similar rate of complete retrieval in the first ERCP attempt.

EPLBD x ES and EPLBD+EST.

Finally, we made an analysis comparing balloon dilation versus both techniques, considering only patients who underwent dilation with balloons equal or bigger than 10 mm. No significant differences were found in PEP.

Conclusions:

The results of our meta-analysis showed that the pancreatitis rate is higher in EPBD compared to EST. However, when considering only balloon ≥10 mm, this difference disappeared. Moreover, PEP rates was also not higher when comparing EPLBD versus EPBL plus EST.