Comparison of long-term outcomes after endoscopic sphincterotomy versus endoscopic papillary balloon dilation: a propensity score-based cohort analysis

• Published in: Journal of gastroenterology Vol. 48; no. 9; pp. 1090 - 1096
• Main Authors: Doi, Shinpei, Yasuda, Ichiro, Mukai, Tsuyoshi, Iwashita, Takuji, Uemura, Shinya, Yamauchi, Takahiro, Nakashima, Masanori, Adachi, Seiji, Shimizu, Masahito, Tomita, Eiichi, Itoi, Takao, Moriwaki, Hisataka
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.09.2013; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Biliary Tract; Cholangitis - etiology; Cholecystitis - etiology; Cohort Studies; Colorectal Surgery; Dilatation - adverse effects; Dilatation - methods; Endoscopy, Gastrointestinal - methods; Female; Gallstones - pathology; Gallstones - surgery; Gallstones - therapy; Gastroenterology; Hepatology; Humans; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article—Liver; Pancreas; Propensity Score; Recurrence; Sphincterotomy, Endoscopic - adverse effects; Sphincterotomy, Endoscopic - methods; Surgical Oncology; Treatment Outcome; Endoscopic papillary balloon dilation; Common bile duct stones; Endoscopic sphincterotomy
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-012-0707-8

Background Endoscopic sphincterotomy (ES) is widely performed in patients with common bile duct stones (CBDS). However, the long-term outcomes of patients following ES have not been sufficiently elucidated. Impaired papillary function following ES may result in additional late complications. In contrast, endoscopic papillary balloon dilation (EPBD)—another option for treating CBDS—is expected to preserve papillary function. This study aimed to compare the long-term outcomes of patients with CBDS treated with ES to those treated with EPBD in a large cohort. In addition, a subgroup analysis was performed, according to gallbladder (GB) status. Methods A cohort study was performed using propensity score matching to reduce treatment selection bias. This involved the analysis of follow-up data for 1086 patients who underwent EPBD or ES for CBDS. Results Propensity score matching extracted 246 pairs of patients. The median (interquartile range) follow-up period after EPBD or ES was 93.5 (46.8–129.2) months and 90 (42–139.3) months, respectively. The incidence of CBDS recurrence after EPBD and ES were 8.5 and 15.0 %, respectively. The hazard ratio (95 % CI) was 0.577 (0.338–0.986) ( P  = 0.044). Based on the status of the GB, the incidence of CBDS recurrence was significantly different between post-EPBD and post-ES in the group with cholecystectomy after EPBD/ES ( P  = 0.013). Conclusions The incidence of biliary complications was significantly lower in patients after EPBD than in those after ES, and this outcome appeared most markedly in patients who also underwent cholecystectomy.