Comparison of late adverse events after endoscopic sphincterotomy versus endoscopic papillary large balloon dilation for common bile duct stones: A propensity score-based cohort analysis

Abstract

Endoscopic sphincterotomy (EST) is a standard procedure for the treatment of common bile duct stones (CBDS). Endoscopic papillary large balloon dilation (EPLBD) is emerging as an effective method to treat difficult CBDS, providing several advantages over EST without increasing the early adverse events (AE). However, the late AE of EPLBD have not been well studied yet.

Aims

To compare the late AEs after EPLBD versus EST for the treatment of CBDS using a propensity score-based cohort analysis.

Methods

Propensity score matching was introduced to reduce the possible bias in baseline characteristics between the two treatment groups and formed the matched 240 patients. The primary endpoint was the cumulative as well as the estimated 1-year and 3-year late AE rates. The secondary outcome was the incidence of early AEs.

Results

The cumulative late AE rates were 12.5% and 15.8%in the ELPBD and EST groups (p=0.972) with a median follow-up period of 915.5 and 1544.5 days, respectively. The estimated 1-year and 3-year late AE rates were 8.4% and 13.1% in the EPLBD group and 5.0% and 15.0% in the EST group. In multivariate analysis, ≥2 procedures were identified as independent risk factors of late AEs. The overall early AE rate did not differ between the groups.

Conclusion

The late AE rate after EPLBD had no significant difference compared with that after EST in this study, which had a relatively long follow-up period. Therefore, EPLBD could be used for the treatment of CBDS, if CBDS is considered difficult to treat.

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