Endoscopic papillary large balloon dilation reduces stone recurrence better than conventional ERCP: Study

China: A recent study by Xu Wang and colleagues found that nearly 50% of the patients with recurring common bile duct stone (CBDS) had a stone recurrence following conventional endoscopic retrograde cholangiopancreatography (ERCP) during the long-term follow-up. The findings of this study were published in The American College of Gastroenterology.

After endoscopic retrograde cholangiopancreatography, up to 60% of patients with recurrent CBDS experience further recurrence. For the majority of patients, there are no reliable ways to stop recurrence. Therefore, the purpose of this study was to evaluate, through a randomized controlled trial, the short- and long-term efficacies of endoscopic papillary large balloon dilation (EPLBD) for the treatment of recurrent CBDS.

For this study, the EPLBD group or the control group received a 1:1 random assignment out of all eligible patients with recurrent CBDS. The CBDS recurrence rate within 2 years of ERCP was the main outcome. The notion of intention-to-treat was used in the analysis.

The key findings of this study were as follows:

1. There were 90 individuals in each group of 180 patients with recurrent CBDS from 2014 to 2021. All patients received one or more procedures of ERCP to completely remove their CBDS.

2. With EPLBD therapy, the rate of total clearance after just one session was much greater and they also had a considerably reduced risk of CBDS recurrence within 2 years of the follow-up than did the control group.

5. CBDS recurrence was discovered in 34.4% of patients (31/90) in the EPLBD group and in 51.1% (46/90) of patients in the control group at a median follow-up of about 56 months.

6. The EPLBD group also had a reduction in multiple recurrences (2) (4.4% vs 18.9%).

Reference:

Wang, X., Wang, X., Sun, H., Ren, G., Wang, B., Liang, S., Zhang, L., Kang, X., Tao, Q., Guo, X., Luo, H., & Pan, Y. (2022). Endoscopic Papillary Large Balloon Dilation Reduces Further Recurrence in Patients With Recurrent Common Bile Duct Stones: A Randomized Controlled Trial. In American Journal of Gastroenterology (Vol. 117, Issue 5, pp. 740–747). https://doi.org/10.14309/ajg.0000000000001690