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Review
. 2020 Nov 25;9(12):3808.
doi: 10.3390/jcm9123808.

Best Procedure for the Management of Common Bile Duct Stones via the Papilla: Literature Review and Analysis of Procedural Efficacy and Safety

Shigeto Ishii  1 , Hiroyuki Isayama  1 , Mako Ushio  1 , Sho Takahashi  1 , Wataru Yamagata  1 , Yusuke Takasaki  1 , Akinori Suzuki  1 , Kazushige Ochiai  1 , Ko Tomishima  1 , Ryo Kanazawa  1 , Hiroaki Saito  1 , Toshio Fujisawa  1 , Shuichiro Shiina  1
Affiliations
Review

Best Procedure for the Management of Common Bile Duct Stones via the Papilla: Literature Review and Analysis of Procedural Efficacy and Safety

Shigeto Ishii et al. J Clin Med. .

Abstract

Background: Endoscopic management of common bile duct stones (CBDS) is standard; however, various techniques are performed via the papilla, and the best procedure in terms of both efficacy and safety has not been determined.

Methods: Endoscopic procedures were classified into five categories according to endoscopic sphincterotomy (EST) and balloon dilation (BD): (1) EST, (2) endoscopic papillary BD (≤10 mm) (EPBD), (3) EST followed by BD (≤10 mm) (ESBD), (4) endoscopic papillary large BD (≥12 mm) (EPLBD), and (5) EST followed by large BD (≥12 mm) (ESLBD). We performed a literature review of prospective and retrospective studies to compare efficacy and adverse events (AEs). Each procedure was associated with different efficacy and AE profiles.

Results: In total, 19 prospective and seven retrospective studies with a total of 3930 patients were included in this study. For EST, the complete stone removal rate at the first session, rate of mechanical lithotripsy (ML), and rate of overall AEs in EST were superior to EPBD, but a higher rate of bleeding was found for EST. Based on one retrospective study, complete stone removal rate at the first session, rate of ML, and rate of overall AEs were superior for ESBD vs. EST, and the rate of bleeding for the former was also lower. Complete stone removal rate at the first session and rate of ML for ESLBD were superior to those for EST, with no significant difference in rate of AEs. For EST vs. EPLBD, complete stone removal rate at the first session and rate of ML were superior for the latter. For EPLBD vs. ESLBD, the efficacy and safety were similar.

Conclusions: ESBD is considered the best procedure for the management of small CBDS, but strong evidence is lacking. For large CBDS, both ESLBD and EPLBD are similar.

Keywords: bleeding; common bile duct stones; endoscopic papillary balloon dilation; endoscopic sphincterotomy; post-ERCP pancreatitis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Forest plot of risk ratios and 95%CIs representing a comparison between EST and EPBD. (A): Complete stone removal at the first endoscopic session (B): Rate of mechanical lithotripsy. (C): Overall adverse events. (D): Bleeding. (E): PEP. (F): Perforation. CI, Confidence interval; EST, endoscopic sphincterotomy; EPBD, endoscopic papillary balloon dilation; PEP, post-endoscopic retrograde cholangiopancreatography pancreatitis.
Figure 1
Figure 1
Forest plot of risk ratios and 95%CIs representing a comparison between EST and EPBD. (A): Complete stone removal at the first endoscopic session (B): Rate of mechanical lithotripsy. (C): Overall adverse events. (D): Bleeding. (E): PEP. (F): Perforation. CI, Confidence interval; EST, endoscopic sphincterotomy; EPBD, endoscopic papillary balloon dilation; PEP, post-endoscopic retrograde cholangiopancreatography pancreatitis.
Figure 2
Figure 2
Forest plot of risk ratios and 95%CIs representing a comparison between EST and ESLBD. (A): Complete stone removal in the first endoscopic session. (B): Rate of mechanical lithotripsy. (C): Overall adverse events. (D): Bleeding. (E): PEP. (F): Perforation. CI, Confidence interval; EST, endoscopic sphincterotomy; ESLBD, endoscopic papillary large balloon dilation with endoscopic sphincterotomy; PEP, post-endoscopic retrograde cholangiopancreatography pancreatitis.
Figure 2
Figure 2
Forest plot of risk ratios and 95%CIs representing a comparison between EST and ESLBD. (A): Complete stone removal in the first endoscopic session. (B): Rate of mechanical lithotripsy. (C): Overall adverse events. (D): Bleeding. (E): PEP. (F): Perforation. CI, Confidence interval; EST, endoscopic sphincterotomy; ESLBD, endoscopic papillary large balloon dilation with endoscopic sphincterotomy; PEP, post-endoscopic retrograde cholangiopancreatography pancreatitis.
Figure 3
Figure 3
Forest plot of risk ratios and 95%CIs representing a comparison between EPLBD and ESLBD. (A): Complete stone removal in the first endoscopic session. (B): Rate of mechanical lithotripsy. (C): Overall adverse events. (D): Bleeding. (E): PEP. (F): Perforation. CI, Confidence interval; EPLBD, endoscopic papillary large balloon dilation without endoscopic sphincterotomy; ESLBD, endoscopic papillary large balloon dilation with endoscopic sphincterotomy; PEP, post-endoscopic retrograde cholangiopancreatography pancreatitis.
Figure 3
Figure 3
Forest plot of risk ratios and 95%CIs representing a comparison between EPLBD and ESLBD. (A): Complete stone removal in the first endoscopic session. (B): Rate of mechanical lithotripsy. (C): Overall adverse events. (D): Bleeding. (E): PEP. (F): Perforation. CI, Confidence interval; EPLBD, endoscopic papillary large balloon dilation without endoscopic sphincterotomy; ESLBD, endoscopic papillary large balloon dilation with endoscopic sphincterotomy; PEP, post-endoscopic retrograde cholangiopancreatography pancreatitis.
Figure 4
Figure 4
(a) A device integrating a sphincterotome and a balloon (StoneMaster V; Olympus Corp., Tokyo, Japan). (b) Two types of balloon sizes that can be used for ESBD and ESLBD. ESBD, endoscopic papillary balloon dilation with endoscopic sphincterotomy; ESLBD, endoscopic papillary large balloon dilation with endoscopic sphincterotomy.
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References

    1. Kawai K. Preliminary report on endoscopic papillotomy. J. Kyoto Pref. Univ. Med. 1973;82:353–355.
    1. Staritz M., Ewe K., Meyer zum Büschenfelde K.H. Endoscopic papillary dilation (EPD) for the treatment of common bile duct stones and papillary stenosis. Endoscopy. 1983;15(Suppl. 1):197–198. doi: 10.1055/s-2007-1021507. - DOI - PubMed
    1. Isayama H., Komatsu Y., Inoue Y., Toda N., Shiratori Y., Tsujino T., Yamada H., Saitou K., Kawabe T., Omata M. Preserved function of the Oddi sphincter after endoscopic papillary balloon dilation. Hepato-Gastroenterology. 2003;50:1787–1791. - PubMed
    1. Fujisawa T., Kagawa K., Hisatomi K., Kubota K., Nakajima A., Matsuhashi N. Is endoscopic papillary balloon dilatation really a risk factor for post-ERCP pancreatitis? World J. Gastroenterol. 2016;22:5909–5916. doi: 10.3748/wjg.v22.i26.5909. - DOI - PMC - PubMed
    1. Disario J.A., Freeman M.L., Bjorkman D.J., Macmathuna P., Petersen B.T., Jaffe P.E., Morales T.G., Hixson L.J., Sherman S., Lehman G.A., et al. Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology. 2004;127:1291–1299. doi: 10.1053/j.gastro.2004.07.017. - DOI - PubMed