S62 Endoscopic Papillary Balloon Dilation vs Sphincterotomy for Common Bile Duct Stones: A Meta-Analysis of Randomized Controlled Trials

Introduction: Endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) are widely used techniques for the management of common bile duct (CBD) stones. Despite their widespread use, comparative safety and efficacy remain debated. This meta-analysis aimed to evaluate and compare the outcomes of EPBD and EST. Methods: A systematic review and meta-analysis were conducted to compare endoscopic papillary balloon dilation and endoscopic sphincterotomy in the management of common bile duct stones. A comprehensive literature search of PubMed, Google Scholar, Cochrane Library, and PLOS databases was performed from 2000 to the present. Only randomized controlled trials involving adult patients were included. The risk of bias was assessed using the Cochrane Risk of Bias tool. Results: Nineteen randomized controlled trials were included. EPBD and EST demonstrated comparable efficacy in stone clearance at first attempt (OR = 1.02; 95% CI, 0.65–1.60; P = 0.94) and requirement for mechanical lithotripsy (OR = 1.00; 95% CI, 0.80–1.24; P = 0.98). However, a borderline statistically significant trend favored EST for overall stone clearance (OR = 0.65; 95% CI, 0.43–1.00; P = 0.05). Notably, EPBD was associated with a significantly higher risk of post-endoscopy retrograde cholangiopancreatography pancreatitis (OR = 1.70; 95% CI, 1.22–2.37; P = 0.002), though overall short-term complications did not differ between the groups (OR = 1.00; 95% CI, 0.66–1.52; P = 0.99). Conclusion: Both EPBD and EST demonstrate similar efficacy in terms of first-attempt stone clearance and need for mechanical lithotripsy. However, EST appears to offer a modest advantage in overall stone clearance and is associated with a significantly lower risk of post- endoscopy retrograde cholangiopancreatography pancreatitis. These findings suggest that while EPBD remains a viable alternative, EST may be the preferred approach, particularly when minimizing the risk of pancreatitis is a clinical priority.