Is Endoscopic Balloon Dilation Still Associated With Higher Rates of Pancreatitis? A Systematic Review and Meta-Analysis

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art_MATSUBAYASHI_Is_Endoscopic_Balloon_Dilation_Still_Associated_With_Higher_2020.PDF (3.01 MB)
Citações na Scopus
10
Tipo de produção
article
Data de publicação
2020
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
LIPPINCOTT WILLIAMS & WILKINS
Autores
HATHORN, Kelly E.
Citação
PANCREAS, v.49, n.2, p.158-174, 2020
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
The objective of this study was to compare the efficacy and safety of endoscopic papillary balloon dilation (EPBD), endoscopic sphincterotomy (ES), and the combination of large balloon dilation and ES (ES + EPLBD) in the treatment of common bile duct stones, with a special focus on postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Individualized search strategies were developed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included randomized controlled trials (RCTs) which evaluated at least one of the following outcomes: PEP, complete stone removal in the first ERCP, need for mechanical lithotripsy, recurrence of common bile duct stones, bleeding, and cholangitis. Twenty-five RCTs were selected for analysis. Pancreatitis rates were higher for EPBD than for ES (P = 0.003), as were severe pancreatitis rates (P = 0.04). However, in the 10-mm or greater balloon subgroup analysis, this difference was not shown (P = 0.82). Rates of PEP were higher in the subgroup of non-Asian subjects (P = 0.02), and the results were not robust when RCTs that used endoscopic nasobiliary drainage were omitted. The incidence of pancreatitis was comparable between EPLBD and ES + EPLBD. All 3 approaches were equally efficacious. Nevertheless, the results should be interpreted with caution, because pancreatitis is a multifactorial pathology, and RCTs can have limited generalizability.
Palavras-chave
common bile duct stone, balloon dilation, endoscopic papillary balloon dilatation, endoscopic sphincterotomy, lithotripsy
URI
https://observatorio.fm.usp.br/handle/OPI/36195
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Coleções
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/35
Artigos e Materiais de Revistas Científicas - LIM/47