scholarly journals The effect of duration time on the efficacy and safety during endoscopic papillary balloon dilation for choledocholithiasis treatment

2020 ◽  
Author(s):  
Yining Wang ◽  
Yuanzhen Hao ◽  
Miao Qi ◽  
Wei Zuo ◽  
Jun-Bo Hong
Keyword(s):  
Short Duration ◽  
Removal Rate ◽  
Balloon Dilation ◽  
Cochrane Library ◽  
Endoscopic Papillary Balloon Dilation ◽  
Stone Clearance ◽  
Mechanical Lithotripsy ◽  
Stone Removal ◽  
Long Duration ◽  
Cbd Stone

Abstract Background Endoscopic papillary balloon dilation (EPBD) has been widely accepted as an alternative to endoscopic sphincterotomy (EST) during therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis treatment. No consensus has been established to define the precise duration of EPBD. Methods The PubMed, EMBASE, Cochrane Library database were systematically searched up to 31 May 2019 for research comparing short duration (≤ 30 seconds) and long duration (≥ 1 minute) of EPBD. Results Seven studies demonstrated that EPBD with long duration was superior than short duration in the stone clearance rate during the first ERCP (OR 0.61, 95%CI [0.48, 0.77], P < 0.001). Long duration exhibited a trend of higher efficacy in total stone removal across all ERCP sessions (OR 0.98, 95%CI [0.73, 1.31], P = 0.89), less frequency of mechanical lithotripsy use (OR 1.22, 95%CI [0.79, 1.89], P = 0.37). Compared with long duration, short balloon time had lower rate of overall complications (OR 0.85, 95%CI [0.70, 1.04], P = 0.11) and post-ERCP pancreatitis (OR 0.81, 95%CI [0.63, 1.03], P = 0.09). No significance was identified in hemorrhage (OR 0.86, 95%CI [0.30, 2.44], P = 0.77), perforation (OR 0.54, 95%CI [0.14, 2.14], P = 0.38) and cholangitis (OR 1.15, 95%CI [0.80, 1.66], P = 0.44). Conclusion Long duration (≥ 1 minute) could significantly increase the efficacy of EPBD in stone removal rate during first ERCP session, manifesting higher rate of total CBD stone clearance and less mechanical lithotripsy. Short EPBD contributed to less overall complications than long EPBD but not significantly.

Sphincterotomy plus balloon dilation versus sphincterotomy alone for choledocholithiasis: a meta-analysis

Endoscopy ◽  
2019 ◽  
Vol 51 (08) ◽  
pp. 763-771 ◽  
Author(s):  
Shou Quan Dong ◽  
Tikka Prabhjot Singh ◽  
Qiu Zhao ◽  
Juan Juan Li ◽  
Hong Ling Wang
Keyword(s):  
Endoscopic Sphincterotomy ◽  
Removal Rate ◽  
Meta Analysis ◽  
Balloon Dilation ◽  
Efficacy And Safety ◽  
Procedure Time ◽  
Endoscopic Retrograde ◽  
Stone Clearance ◽  
Mechanical Lithotripsy ◽  
Cbd Stones

Abstract Background Endoscopic sphincterotomy plus balloon dilation (ESBD) is considered to be a promising method for the removal of large common bile duct (CBD) stones. However, when compared with endoscopic sphincterotomy (EST) alone, the efficacy and safety of ESBD remain controversial. This meta-analysis aimed to compare the efficacy and safety of ESBD vs. EST for the removal of large CBD stones. Methods Electronic databases were searched up to 15 July 2018 for literature that compared ESBD with EST for the removal of CBD stones. Pooled odds ratios (ORs) of the stone clearance rate and the complication rate were used to compare the efficacy and safety of ESBD vs. EST. Results A total of 18 studies with 2789 patients were included. The results showed that the stone removal rate was much higher in the ESBD group than in the EST group, both across all endoscopic retrograde cholangiopancreatography (ERCP) sessions (OR 2.68, 95 % confidence interval [CI] 1.79 to 4.01) and during the first ERCP session (OR 2.07, 95 %CI 1.37 to 3.12). The ESBD group had fewer complications than EST alone (OR 0.63, 95 %CI 0.47 to 0.85). Moreover, the ESBD group needed less mechanical lithotripsy (OR 0.38, 95 %CI 0.24 to 0.61) and had a shorter procedure time (mean difference – 4.05, 95 %CI – 7.02 to – 1.09) than EST alone. Conclusion The efficacy and safety of ESBD were superior to those of EST for the removal of large CBD stones. Moreover, less mechanical lithotripsy and shorter procedure times were needed with ESBD to manage large stones.

scholarly journals Endoscopic Sphincterotomy with Large Balloon Dilation versus Endoscopic Sphincterotomy for Bile Duct Stones: A Systematic Review and Meta-Analysis

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Lei Xu ◽  
Moe Htet Kyaw ◽  
Yee Kit Tse ◽  
James Yun Wong Lau
Keyword(s):  
Bile Duct ◽  
Endoscopic Sphincterotomy ◽  
Removal Rate ◽  
Balloon Dilation ◽  
Bile Duct Stones ◽  
Safety And Efficacy ◽  
Mechanical Lithotripsy ◽  
Stone Removal ◽  
Large Balloon ◽  
Large Balloon Dilation

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.

scholarly journals Effects Comparison between Endoscopic Papillary Large Balloon Dilatation and Endoscopic Sphincterotomy for Common Bile Duct Stone Removal

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Yandong Guo ◽  
Chen Li ◽  
Shan Lei ◽  
Fachao Zhi
Keyword(s):  
Bile Duct ◽  
Endoscopic Sphincterotomy ◽  
Treatment Duration ◽  
Balloon Dilatation ◽  
Bile Duct Stone ◽  
Removal Rate ◽  
Mechanical Lithotripsy ◽  
Stone Removal ◽  
Large Balloon ◽  
Complications Rate

Endoscopic sphincterotomy (EST) is a treatment of choice for stone extraction and is now most frequently used. The study was to compare the efficacy of endoscopic papillary large balloon dilatation (EPLBD) and endoscopic sphincterotomy (EST) for common bile duct stone removal. Trials comparing the effects between EPLBD and EST treatment were searched according to the study protocol. Overall stone removal rate, complete removal rate in 1st session, treatment duration, mechanical lithotripsy using rate, and overall complication rate were compared using risk ratio (RR) and mean difference (MD) and their 95% confidence interval (CI) via RevMan 5.2 software. For overall stone removal rate, two therapies showed similar effect, but EPLBD showed better overall stone removal rate for stone >10 mm in diameter. For complete stone removal rate in 1st session, no difference was found, even for those with stone >10 mm in diameter; EPLBD showed longer treatment duration, higher mechanical lithotripsy using rate obvious overall complications rate, and more serious bleeding, whereas there were no significant differences for perforation, hyperamylasemia, pancreatitis, and cholecystitis/cholangitis. EPLBD showed better efficacy in certain conditions compared to EST, however with shortcomings, such as more duration, higher mechanical lithotripsy using rate, more serious overall complications rate, and bleeding.

Endoscopic papillary balloon dilation for bile duct stone removal in patients 60 years old or younger

2010 ◽  
Vol 45 (10) ◽  
pp. 1072-1079 ◽  
Author(s):  
Takeshi Tsujino ◽  
Haruhiko Yoshida ◽  
Hiroyuki Isayama ◽  
Yukiko Ito ◽  
Yoko Yashima ◽  
...  
Keyword(s):  
Bile Duct ◽  
Bile Duct Stone ◽  
Balloon Dilation ◽  
Endoscopic Papillary Balloon Dilation ◽  
Stone Removal

Digital cholangioscopy-guided laser versus mechanical lithotripsy for large bile duct stone removal after failed papillary large-balloon dilation: a randomized study

Endoscopy ◽  
2019 ◽  
Vol 51 (11) ◽  
pp. 1066-1073 ◽  
Author(s):  
Phonthep Angsuwatcharakon ◽  
Santi Kulpatcharapong ◽  
Wiriyaporn Ridtitid ◽  
Chaloemphon Boonmee ◽  
Panida Piyachaturawat ◽  
...  
Keyword(s):  
Bile Duct ◽  
Radiation Exposure ◽  
Clearance Rate ◽  
Balloon Dilation ◽  
Laser Lithotripsy ◽  
Stone Clearance ◽  
Mechanical Lithotripsy ◽  
Cbd Stones ◽  
Large Balloon ◽  
Large Balloon Dilation

Abstract Background Endoscopic papillary large-balloon dilation (EPLBD) allows for the complete removal of large common bile duct (CBD) stones without fragmentation; however, a significant proportion of very large stones and stones floating above a tapering CBD require lithotripsy. Mechanical lithotripsy and cholangioscopy-guided laser lithotripsy are both effective for stone fragmentation. This study aimed to directly compare, for the first time, the efficacy of these two techniques in terms of stone clearance rate, procedure duration, patient radiation exposure, and safety. Methods 32 patients with very large CBD stones or with stones floating above a tapering CBD, and in whom extraction after standard sphincterotomy and/or EPLBD had failed, were randomly assigned to mechanical lithotripsy or cholangioscopy-guided laser lithotripsy at two tertiary referral centers. Crossover was allowed as a rescue treatment if the assigned technique failed. Results Patients’ demographic data were not different between the two groups. Mechanical lithotripsy had a significantly lower stone clearance rate in the first session compared with laser lithotripsy (63% vs. 100%; P < 0.01). Laser lithotripsy rescued 60% of patients with failed mechanical lithotripsy by achieving complete stone clearance within the same session. Radiation exposure of patients was significantly higher in the mechanical lithotripsy group than in the laser lithotripsy group (40 745 vs. 20 989 mGycm2; P  = 0.04). Adverse events (13% vs. 6%; P  = 0.76) and length of hospital stay (1 vs. 1 day; P  = 0.27) were not different. Conclusions Although mechanical lithotripsy is the standard of care for a very large CBD stone after failed EPLBD, where available, cholangioscopy-guided laser lithotripsy is considered the better option for the treatment of this entity as it provides a higher success rate and lower radiation exposure.

scholarly journals Endoscopic Papillary Large Balloon Dilation Reduces the Need for Mechanical Lithotripsy in Patients with Large Bile Duct Stones: A Systematic Review and Meta-Analysis

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Mohammad F. Madhoun ◽  
Sachin Wani ◽  
Sam Hong ◽  
William M. Tierney ◽  
John T. Maple
Keyword(s):  
Bile Duct ◽  
Adverse Events ◽  
Fixed Effects ◽  
Balloon Dilation ◽  
Bile Duct Stones ◽  
Stone Clearance ◽  
Mechanical Lithotripsy ◽  
Large Balloon ◽  
Large Balloon Dilation ◽  
Large Bile Duct

Background. Removal of large stones can be challenging and frequently requires the use of mechanical lithotripsy (ML). Endoscopic papillary large balloon dilation (EPLBD) following endoscopic sphincterotomy (ES) is a technique that appears to be safe and effective. However, data comparing ES + EPLBD with ES alone have not conclusively shown superiority of either technique. Objective. To assess comparative efficacies and rate of adverse events of these methods. Method. Studies were identified by searching nine medical databases for reports published between 1994 and 2013, using a reproducible search strategy. Only studies comparing ES and ES + EPLBD with regard to large bile duct stone extraction were included. Pooling was conducted by both fixed-effects and random-effects models. Risk ratio (RR) estimates with 95% confidence interval (CI) were calculated. Results. Seven studies (involving 902 patients) met the inclusion criteria; 3 of 7 studies were prospective trials. Of the 902 patients, 463 were in the ES + EPLBD group, whereas 439 underwent ES alone. There were no differences noted between the groups with regard to overall stone clearance (98% versus 95%, RR  =  1.01 [0.97, 1.05]; P =0.60) and stone clearance at the 1st session (87% versus 79%, RR = 1.11 [0.98, 1.25]; P =0.11). ES + EPLBD was associated with a reduced need for ML compared to ES alone (15% versus 32%; RR  =  0.49 [0.32, 0.74]; P = 0.0008) and was also associated with a reduction in the overall rate of adverse events (11% versus 18%; RR = 0.58 [0.41, 0.81]; P =0.001). Conclusions. ES + EPLBD has similar efficacy to ES alone while significantly reducing the need for ML. Further, ES + EPLBD appears to be safe, with a lower rate of adverse events than traditional ES. ES + EPLBD should be considered as a first-line technique in the management of large bile duct stones.

ID: 3523609 EFFICACY OF ERCP FOR DIFFICULT BILE DUCT STONE CLEARANCE: ENDOSCOPIC PAPILLARY BALLOON DILATION WITH STENT VERSUS STENT

2021 ◽  
Vol 93 (6) ◽  
pp. AB133
Author(s):  
Marco Alburquerque ◽  
Nati Zaragoza ◽  
Isabel Miguel ◽  
Montserrat Figa ◽  
Eva Pijoan Comas ◽  
...  
Keyword(s):  
Bile Duct ◽  
Bile Duct Stone ◽  
Balloon Dilation ◽  
Endoscopic Papillary Balloon Dilation ◽  
Stone Clearance

scholarly journals A cumulative meta-analysis of endoscopic papillary balloon dilation versus endoscopic sphincterotomy for removal of common bile duct stones

Endoscopy ◽  
2019 ◽  
Vol 51 (06) ◽  
pp. 548-559 ◽  
Author(s):  
Alberto Tringali ◽  
Matteo Rota ◽  
Marta Rossi ◽  
Cesare Hassan ◽  
Douglas G. Adler ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Sphincterotomy ◽  
Meta Analysis ◽  
Balloon Dilation ◽  
Efficacy And Safety ◽  
Endoscopic Papillary Balloon Dilation ◽  
Stone Size ◽  
Stone Clearance ◽  
Over Time

Abstract Background Endoscopic papillary balloon dilation (EPBD) was introduced to overcome the risk of adverse events associated with endoscopic sphincterotomy in the removal of common bile duct (CBD) stones. We performed a meta-analysis of randomized controlled trials (RCTs) comparing efficacy and safety of EPBD vs. endoscopic sphincterotomy, focusing on stone size, balloon diameter, and balloon dilation time. Methods A multiple database search was performed, including MEDLINE, EMBASE and Cochrane Library, from their inception date until October 2017. RCTs comparing the efficacy and safety of EPBD vs. endoscopic sphincterotomy in the removal of CBD stones were included. Cumulative meta-analyses over time, and subgroup analyses according to stone size, and balloon diameter and dilation time were carried out. Results 25 RCTs met the inclusion criteria. Despite the cumulative meta-analysis showing a trend over time in favor of endoscopic sphincterotomy in studies published up to 2004, the conventional meta-analysis revealed that EPBD was equally efficacious compared with endoscopic sphincterotomy in stone removal at first attempt (odds ratio [OR] 0.95, 95 % confidence interval [CI] 0.65 – 1.38). Endoscopic sphincterotomy was superior to EPBD in terms of overall stone clearance (OR 0.65, 95 %CI 0.43 – 0.99) in studies published since 2002, but no differences emerged in studies using large ( ≥ 10 mm) balloons (OR 1.37, 95 %CI 0.72 – 2.62). No statistically significant difference in pancreatitis occurrence emerged between EPBD and endoscopic sphincterotomy (OR 1.35, 95 %CI 0.90 – 2.03). Pancreatitis was more common with EPBD than with endoscopic sphincterotomy in studies using balloons < 10 mm (OR 1.78, 95 %CI 1.07 – 2.97), whereas no difference emerged in studies using large balloons (OR 0.84, 95 %CI 0.46 – 1.53). EPBD had lower rates of bleeding and cholecystitis. Conclusions Our latest data confirm that EPBD is currently inferior to endoscopic sphincterotomy in terms of overall stone clearance. However, EPBD using large balloons (≥ 10 mm) was as effective as endoscopic sphincterotomy, both in stone clearance and the need for endoscopic mechanical lithotripsy, without carrying an increased risk of pancreatitis.

Intelligent difficulty scoring and assistance system for endoscopic extraction of common bile duct stones based on deep learning: multicenter study

Endoscopy ◽  
2020 ◽  
Author(s):  
Li Huang ◽  
Xiaoyan Lu ◽  
Xu Huang ◽  
Xiaoping Zou ◽  
Lianlian Wu ◽  
...  
Keyword(s):  
Deep Learning ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Balloon Dilation ◽  
Technical Difficulty ◽  
Assistance System ◽  
Stone Clearance ◽  
Cbd Stones ◽  
Endoscopic Extraction ◽  
Cbd Stone

Abstract Background The study aimed to construct an intelligent difficulty scoring and assistance system (DSAS) for endoscopic retrograde cholangiopancreatography (ERCP) treatment of common bile duct (CBD) stones. Methods 1954 cholangiograms were collected from three hospitals for training and testing the DSAS. The D-LinkNet34 and U-Net were adopted to segment the CBD, stones, and duodenoscope. Based on the segmentation results, the stone size, distal CBD diameter, distal CBD arm, and distal CBD angulation were estimated. The performance of segmentation and estimation was assessed by mean intersection over union (mIoU) and average relative error. A technical difficulty scoring scale, which was used for assessing the technical difficulty of CBD stone removal, was developed and validated. We also analyzed the relationship between scores evaluated by the DSAS and clinical indicators including stone clearance rate and need for endoscopic papillary large-balloon dilation (EPLBD) and lithotripsy. Results The mIoU values of the stone, CBD, and duodenoscope segmentation were 68.35 %, 86.42 %, and 95.85 %, respectively. The estimation performance of the DSAS was superior to nonexpert endoscopists. In addition, the technical difficulty scoring performance of the DSAS was more consistent with expert endoscopists than two nonexpert endoscopists. A DSAS assessment score ≥ 2 was correlated with lower stone clearance rates and more frequent EPLBD. Conclusions An intelligent DSAS based on deep learning was developed. The DSAS could assist endoscopists by automatically scoring the technical difficulty of CBD stone extraction, and guiding the choice of therapeutic approach and appropriate accessories during ERCP.

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