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Diagnostic and Therapeutic Endoscopy
Volume 2014 (2014), Article ID 309618, 8 pages
Review Article

Endoscopic Papillary Large Balloon Dilation Reduces the Need for Mechanical Lithotripsy in Patients with Large Bile Duct Stones: A Systematic Review and Meta-Analysis

1Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, WP1345, Oklahoma City, OK 73104, USA
2Division of Gastroenterology and Hepatology, University of Colorado, Anschutz Medical Campus, and Veterans Affairs Medical Center, Aurora, Denver, CO, USA

Received 19 November 2013; Accepted 27 January 2014; Published 6 March 2014

Academic Editor: Tony C.K. Tham

Copyright © 2014 Mohammad F. Madhoun et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Removal of large stones can be challenging and frequently requires the use of mechanical lithotripsy (ML). Endoscopic papillary large balloon dilation (EPLBD) following endoscopic sphincterotomy (ES) is a technique that appears to be safe and effective. However, data comparing ES + EPLBD with ES alone have not conclusively shown superiority of either technique. Objective. To assess comparative efficacies and rate of adverse events of these methods. Method. Studies were identified by searching nine medical databases for reports published between 1994 and 2013, using a reproducible search strategy. Only studies comparing ES and ES + EPLBD with regard to large bile duct stone extraction were included. Pooling was conducted by both fixed-effects and random-effects models. Risk ratio (RR) estimates with 95% confidence interval (CI) were calculated. Results. Seven studies (involving 902 patients) met the inclusion criteria; 3 of 7 studies were prospective trials. Of the 902 patients, 463 were in the ES + EPLBD group, whereas 439 underwent ES alone. There were no differences noted between the groups with regard to overall stone clearance (98% versus 95%, RR = 1.01 [0.97, 1.05]; ) and stone clearance at the 1st session (87% versus 79%, RR = 1.11 [0.98, 1.25]; ). ES + EPLBD was associated with a reduced need for ML compared to ES alone (15% versus 32%; RR = 0.49 [0.32, 0.74]; ) and was also associated with a reduction in the overall rate of adverse events (11% versus 18%; RR = 0.58 [0.41, 0.81]; ). Conclusions. ES + EPLBD has similar efficacy to ES alone while significantly reducing the need for ML. Further, ES + EPLBD appears to be safe, with a lower rate of adverse events than traditional ES. ES + EPLBD should be considered as a first-line technique in the management of large bile duct stones.