Intervention Review

Endoscopic balloon sphincter dilation (sphincteroplasty) versus sphincterotomy for common bile duct stones

  1. Benjamin Weinberg1,*,
  2. Waleed Shindy2,
  3. Simon Lo1

Editorial Group: Cochrane Hepato-Biliary Group

Published Online: 18 OCT 2006

Assessed as up-to-date: 21 AUG 2006

DOI: 10.1002/14651858.CD004890.pub2

How to Cite

Weinberg B, Shindy W, Lo S. Endoscopic balloon sphincter dilation (sphincteroplasty) versus sphincterotomy for common bile duct stones. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004890. DOI: 10.1002/14651858.CD004890.pub2.

Author Information

  1. 1

    West Hollywood, USA

  2. 2

    Gastroenterology, Sylmar, CA, USA

*Benjamin Weinberg, 932 N Curson Ave Apt #3, West Hollywood, CA 90046, USA. benjaminweinberg@yahoo.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 OCT 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Endoscopic balloon dilation was introduced as an alternative to endoscopic sphincterotomy to preserve the sphincter of Oddi and avoid undesirable effects due to an incompetent sphincter. Endoscopic balloon dilation has been largely abandoned by USA endoscopists due to increased risks of pancreatitis noted in one multicentre trial, but is still practiced in parts of Asia and Europe.

Objectives

To assess the beneficial and harmful effects of endoscopic balloon dilation versus endoscopic sphincterotomy in the management of common bile duct stones.

Search methods

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, and EMBASE until January 2004. We hand searched Gastrointestinal Endoscopy (1983 to 2002), read through bibliographies of all included randomised clinical trials, and contacted all primary authors regarding missed randomised trials.

Selection criteria

Randomised clinical trials comparing endoscopic balloon dilation versus endoscopic sphincterotomy in removal of common bile duct stones irrespective of publication status, language, or blinding.

Data collection and analysis

Data collection was done by two independent authors for decisions on study inclusion, data abstraction, and quality assessment. When there was a non-resolvable discrepancy, the third author made the final decision. Analysis was run with RevMan Analysis.

Main results

Fifteen randomised trials met our inclusion criteria (1768 participants). Less than half of the trials reported adequate methods of randomisation and only two trials used blinded outcome assessment. Endoscopic balloon dilation is statistically less successful for stone removal (relative risk (RR) 0.90, 95% confidence interval (CI) 0.84 to 0.97, random-effects), requires higher rates of mechanical lithotripsy (RR 1.34, 95% CI 1.08 to 1.66, random-effects), and carries a higher risk of pancreatitis (RR 1.98, 95 CI 1.35 to 2.90, fixed-effect). Conversely, endoscopic balloon dilation has statistically significant lower rates of bleeding. Endoscopic balloon dilation leads to significantly less short-term infection and long-term infection. There was no statistically significant difference with regards to mortality, perforation, or total short-term complications between endoscopic balloon dilation and endoscopic sphincterotomy.

Authors' conclusions

Endoscopic balloon dilation is slightly less successful than endoscopic sphincterotomy in stone extraction and more risky regarding pancreatitis. However, endoscopic balloon dilation seems to have a clinical role in patients who have coagulopathy, who are at risk for infection, and possibly in those who are older.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Endoscopic balloon dilation seems inferior to endoscopic sphincterotomy for common bile duct stone removal

Endoscopic balloon dilation is slightly less successful than endoscopic sphincterotomy in stone extraction and more risky in inducing pancreatitis. However, endoscopic balloon dilation seems to have a clinical role in patients who have a coagulopathy, who are at risk for infection, and possibly in those who are older.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

比較內視鏡下取石氣球擴張法 (括約肌成形術)和括約肌切開術針對總膽管結石之治療

內視鏡下取石氣球擴張法為內視鏡下括約肌切開術的替代選擇以保護歐迪氏括約肌,避免由於括約肌機能不全造成的不良影響。由於一項多中心對照試驗提到該方法會增加胰臟炎的風險,所以美國內視鏡醫生非常反對使用,但是,亞洲和歐洲的部分地區仍然還是使用這種方法。

目標

評估內視鏡下取石氣球擴張法對比內視鏡下乳頭括約肌切開術用於治療總膽管結石的利弊。

搜尋策略

我們研究至2004年1月以前The Cochrane Library的The Cochrane HepatoBiliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE和 EMBASE等資料庫。 我們手動搜索胃腸內視鏡檢查法 (1983年−2002年), 流覽所有包含的隨機臨床試驗的目錄,聯繫所有被忽略的隨機試驗的原始作者。

選擇標準

比較內視鏡下取石氣球擴張法和內視鏡下乳頭括約肌切開術用於移除總膽管結石的隨機臨床試驗,不受發表狀態,語言或盲法的限制。

資料收集與分析

2位作者獨立收集資料,決定研究是否被收錄,提取資料,評估品質。 如果出現不可解決的矛盾,第3位作者將會做出最終決定。 使用RevMan 完成分析。

主要結論

共有15個隨機試驗符合我們的收錄標準 (1768受試者)。 不到一半的試驗有記錄充足的隨機化方法,只有兩個試驗使用盲法評估結果。內視鏡下取石氣球擴張法明顯不能成功移除膽石 (相對風險度(RR) 0.90, 95% 信賴區間 (CI) 0.84 0.97, 隨機效果),需要使用機械碎石術的機率更高(RR 1.34, 95% CI 1.08 1.66, 隨機效果), 引起胰臟炎的風險更大 (RR 1.98, 95 CI 1.35 2.90, 固定效果)。相反,內視鏡下取石氣球擴張法具有統計學意義上明顯較低的出血率。內視鏡下取石氣球擴張法使得短期和長期感染明顯較低。內視鏡下取石氣球擴張法和內視鏡下乳頭括約肌切開術在死亡率,穿孔,總體短期併發症方面沒有顯著差異。

作者結論

內視鏡下取石氣球擴張法不如內視鏡下乳頭括約肌切開術能夠順利移除總膽管結石,引起胰臟炎的風險較高。 但是對於凝血病,存在感染風險,或是老年病人來說,採用內視鏡下取石氣球擴張法具有臨床角色。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

內視鏡下取石氣球擴張法不如內視鏡下乳頭括約肌切開術能夠順利移除總膽管結石。內視鏡下取石氣球擴張法不如內視鏡下乳頭括約肌切開術能夠順利移除膽石,引起胰臟炎的風險較高。但是對於凝血病,存在感染風險,或是老年病人來說,採用內視鏡下取石氣球擴張法具有臨床角色。