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|· 영문제목||Comparative efficacy of various endoscopic techniques for the treatment of common bile duct stones: A network meta-analysis|
|· 저자||Park CH, Jung JH, Nam E, Kim EH, Kim MG, Kim JH, Park SW|
|· 발행정보||GASTROINTESTINAL ENDOSCOPY|
Background and Aims: Although various endoscopic techniques have been introduced for successful removal of common bile duct (CBD) stones, the optimal method is not yet clear. We aimed to compare the efficacy of different endoscopic techniques for CBD stone removal.
Methods: We searched for all relevant randomized controlled trials published until June 2017,examining the outcomes of endoscopic techniques for CBD stone removal, including endoscopic sphincterotomy (EST), endoscopic papillary balloon dilatation (EPBD), and endoscopic sphincterotomy with balloon dilatation (ESBD). A Bayesian network meta-analysis was performed.
Results: Twenty-five studies with 3,726 patients were included in the meta-analysis. ESBD had a higher successful rate of stone removal in the first endoscopic session than EPBD (odds ratio [OR] [95% credible interval [CrI]], 2.09 [1.07-4.16]). Mechanical lithotripsy was less common in ESBD
than in EPBD (OR [95% CrI], 0.45 [0.25-0.83]). EPBD revealed a lower risk of bleeding than bothEST and ESBD (OR [95% CrI], vs EST, 0.06 [0.008-0.23]; vs ESBD, 0.12 [0.01-0.64]). The pooled incidences of bleeding were 3.0% (95% confidence interval [CI], 1.8%-5.2%), 1.1% (95% CI, 0.6%- 2.0%), and 2.0% (95% CI, 0.9%-4.4%) in the EST, EPBD, and ESBD groups, respectively. Pancreatitis tended to be more common in EPBD than in both EST and ESBD (OR [95% CrI]: vs EST,
1.49 [0.84-2.59]; vs ESBD, 1.49 [0.61-3.57]).
Conclusion: The efficacy of ESBD in stone removal during the first endoscopic session was superior to that of EPBD. Pancreatitis in ESBD and EST tended to be less common than in EPBD, although this difference was not statistically significant. However, ESBD and EST carried a higher risk of bleeding than EPBD.