PMID- 36531684
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221222
IS  - 2364-3722 (Print)
IS  - 2196-9736 (Electronic)
IS  - 2196-9736 (Linking)
VI  - 10
IP  - 12
DP  - 2022 Dec
TI  - Endoscopic sphincterotomy vs papillary large balloon dilation vs combination 
      modalities for large common bile duct stones: a network meta-analysis.
PG  - E1599-E1607
LID - 10.1055/a-1958-2348 [doi]
AB  - Background and study aims  The optimal technique for removal of large common bile 
      duct (CBD) stones (>/= 10 mm) during endoscopic retrograde cholangiopancreatography 
      (ERCP) remains unclear. We aimed to perform a comparative analysis between 
      different endoscopic techniques. Methods  Adhering to PRISMA guidelines, a 
      stringent search of the following databases through January 12, 2021, were 
      undertaken: PubMed/Medline, Embase, Web of Science, and Cochrane. Randomized 
      controlled trials comparing the following endoscopic techniques were included: 
      (1) Endoscopic sphincterotomy (EST); (2) Endoscopic papillary large balloon 
      dilation (EPLBD); and (3) EST plus large balloon dilation (ESLBD). Stone 
      clearance rate (SCR) on index ERCP was the primary outcome/endpoint. Need for 
      mechanical lithotripsy (ML) and adverse events were also evaluated as secondary 
      endpoint. Random effects model and frequentist approach were used for statistical 
      analysis. Results  A total of 16 studies with 2545 patients (1009 in EST group, 
      588 in EPLBD group, and 948 patients in ESLBD group) were included. The SCR was 
      significantly higher in ESLBD compared to EST risk ratio [RR]: 1.11, [confidence 
      interval] CI: 1.00-1.24). Lower need for ML was noted for ESLBD (RR: 0.48, CI: 
      0.31-0.74) and EPLBD (RR: 0.58, CI: 0.34-0.98) compared to EST. All other 
      outcomes including bleeding, perforation, post-ERCP pancreatitis, stone 
      recurrence, cholecystitis, cholangitis, and mortality did not show significant 
      difference between the three groups. Based on network ranking, ESLBD was superior 
      in terms of SCR as well as lower need for ML and adverse events (AEs). 
      Conclusions  Based on network meta-analysis, ESLBD seems to be superior with 
      higher SCR and lower need for ML and AEs for large CBD stones.
CI  - The Author(s). This is an open access article published by Thieme under the terms 
      of the Creative Commons Attribution-NonDerivative-NonCommercial License, 
      permitting copying and reproduction so long as the original work is given 
      appropriate credit. Contents may not be used for commercial purposes, or adapted, 
      remixed, transformed or built upon. 
      (https://creativecommons.org/licenses/by-nc-nd/4.0/).
FAU - Aziz, Muhammad
AU  - Aziz M
AD  - Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio.
FAU - Khan, Zubair
AU  - Khan Z
AD  - Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical 
      School, Houston, Texas.
FAU - Haghbin, Hossein
AU  - Haghbin H
AD  - Division of Gastroenterology, Ascension providence Hospital, Southfield, 
      Michigan, United States.
FAU - Kamal, Faisal
AU  - Kamal F
AD  - Division of Gastroenterology, University of California, San Francisco, 
      California, United States.
FAU - Sharma, Sachit
AU  - Sharma S
AD  - Division of Gastroenterology, Virginia Commonwealth University, Richmond, 
      Virginia, United States.
FAU - Lee-Smith, Wade
AU  - Lee-Smith W
AD  - University of Toledo Libraries, University of Toledo, Toledo, Ohio, United 
      States.
FAU - Pervez, Asad
AU  - Pervez A
AD  - Division of Gastroenterology, West Virginia University, Morgantown, West 
      Virginia, United States.
FAU - Alastal, Yaseen
AU  - Alastal Y
AD  - Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio.
FAU - Nawras, Ali
AU  - Nawras A
AD  - Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio.
FAU - Thosani, Nirav
AU  - Thosani N
AD  - Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical 
      School, Houston, Texas.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20221215
PL  - Germany
TA  - Endosc Int Open
JT  - Endoscopy international open
JID - 101639919
PMC - PMC9754880
COIS- Competing interests N. Thosani is consultant for Boston Scientific Corp, Pentax 
      America, Ambu. He has received royalty from UpToDate and is speaker for Abbvie. 
      He has creatorship rights for ROSEAId inc.
EDAT- 2022/12/20 06:00
MHDA- 2022/12/20 06:01
PMCR- 2022/12/01
CRDT- 2022/12/19 03:57
PHST- 2021/12/16 00:00 [received]
PHST- 2022/10/04 00:00 [accepted]
PHST- 2022/12/19 03:57 [entrez]
PHST- 2022/12/20 06:00 [pubmed]
PHST- 2022/12/20 06:01 [medline]
PHST- 2022/12/01 00:00 [pmc-release]
AID - 10.1055/a-1958-2348 [doi]
PST - epublish
SO  - Endosc Int Open. 2022 Dec 15;10(12):E1599-E1607. doi: 10.1055/a-1958-2348. 
      eCollection 2022 Dec.