Balloon Dilation With Adequate Duration Is Safer Than Sphincterotomy for Extracting Bile Duct Stones: A Systematic Review and Meta-analyses

Wei Chih Liao, Yu Kang Tu, Ming Shiang Wu, Hsiu Po Wang, Jaw Town Lin, Joseph W. Leung, Kuo Liong Chien

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


Background & Aims: Endoscopic sphincterotomy (EST) is the standard treatment for choledocholithiasis. Endoscopic papillary balloon dilation (EPBD) has a lower risk for bleeding than EST, but EPBD is reserved for patients with bleeding diathesis because some studies reported that it increases the risk for pancreatitis. A short dilation time (≤1 minute) is therefore recommended to reduce pancreatitis. However, there is evidence for an inverse relationship between EPBD duration and pancreatitis, prompting reevaluation of the optimal duration and relative safety of EPBD vs EST. Methods: We systematically reviewed randomized controlled trials to compare long EPBD (>1 minute), short EPBD (≤1 minute), and EST regarding pancreatitis and overall complications. In addition to pairwise meta-analyses, Bayesian network meta-analysis was undertaken to compare the 3 procedures together. Relation between duration and outcome was also analyzed by meta-regression. Results: Compared with EST, short EPBD had a higher risk for pancreatitis (odds ratio [OR] by traditional analysis, 3.87; 95% confidence interval, 1.08-13.84 and OR by network meta-analysis, 4.14; 95% credible interval, 1.58-12.56), but long EPBD did not pose a higher risk than EST (1.14, 0.56-2.35 and 1.07, 0.38-2.76). Long EPBD had a lower overall rate of complications than EST (0.61, 0.36-1.04 and 0.54, 0.20-1.36). In network meta-analysis, probabilities of being the safest treatment for long EPBD/short EPBD/EST regarding pancreatitis and overall complications were 43.9%/0.2%/55.9% and 90.3%/1.3%/8.4%, respectively. Conclusions: Duration of EPBD is inversely associated with pancreatitis risk. Currently recommended ≤1-minute dilation actually increases pancreatitis. EPBD with adequate duration may be preferred over EST because of comparable pancreatitis but lower overall complication rates.

Original languageEnglish (US)
Pages (from-to)1101-1109
Number of pages9
JournalClinical Gastroenterology and Hepatology
Issue number10
StatePublished - Oct 2012
Externally publishedYes


  • Gallbladder
  • Mixed Treatment Comparison
  • Risk Factor
  • Sphincteroplasty

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology


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