Clinical effect of endoscopic sphincterotomy with balloon dilation versus sphincterotomy alone in treatment of large common bile duct stones: A Meta-analysis

Objective To investigate the clinical effect of endoscopic sphincterotomy with balloon dilation( ESBD) versus sphincterotomy( EST) alone in the treatment of large common bile duct stones. Methods Foreign databases( including PubMed,Cochrane Central,and Embase) and Chinese databases( including CNKI and Wanfang Data) were searched for randomized controlled trials( RCTs) on the clinical effect of ESBD versus EST in the treatment of large common bile duct stones published up to July 8,2019. Related data were extracted and RevMan5. 3 was used for analysis. Results A total of 13 RCTs with 1926 patients were included,with 973 patients in the ESBD group and953 patients in the EST group. The meta-analysis showed that there were significant differences between the ESBD group and the EST group in stone clearance rate( odds ratio [OR]= 1. 53,95% confidence interval [CI]: 1. 03-2. 29,P = 0. 04),one-time clearance rate( OR= 1. 77,95% CI: 1. 06-2. 93,P = 0. 03),rate of use of mechanical lithotripsy( OR = 0. 40,95% CI: 0. 25-0. 63,P < 0. 000 1),bleeding rate( OR = 0. 23,95% CI: 0. 11-0. 50,P < 0. 001),incidence rate of cholangitis( OR = 0. 31,95% CI: 0. 12-0. 78,P = 0. 01),incidence rate of early complications( OR = 0. 59,95% CI: 0. 42-0. 84,P = 0. 003),and time of operation( mean difference =-8. 89,95% CI:-17. 56 to-0. 22,P = 0. 04),while there were no significant differences between the two groups in perforation( OR = 0. 27,95% CI: 0. 05-1. 30,P = 0. 10) and pancreatitis after endoscopy( OR = 1. 03,95% CI: 0. 66-1. 61,P = 0. 91). Conclusion In endoscopic treatment of large common bile duct stones,ESBD has several advantages over EST in stone clearance rate,rate of use of mechanical lithotripsy,bleeding rate,incidence rate of cholangitis,and time of operation.