SynthesisDigestive diseases and sciences2026
Endoscopic Sphincterotomy Plus Large Balloon Dilation Versus Endoscopic Sphincterotomy Alone for Patients with Common Bile Duct Stones: A GRADE Evaluation of Systematic Review and Meta-Analysis.
Synthesis in Digestive diseases and sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionEndoscopic sphincterotomy (ES) and endoscopic papillary balloon dilation (EPBD) are established treatments for common bile duct (CBD) stones, each with limitations. Endoscopic sphincterotomy with large-balloon dilation (ESBD) combines both techniques, but its efficacy versus ES alone remains controversial. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing ESBD with ES alone for the management of CBD stones.
methodsWe searched PubMed, Scopus, Embase, Ovid, Web of Science, and Cochrane Library for RCTs comparing ESBD versus ES alone in adults with CBD stones. Primary outcomes were total and first-session stone clearance and mechanical lithotripsy (ML) use. Secondary outcomes included procedure time and complications. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using fixed or random effect models based on heterogeneity. Subgroup analysis was performed based on stone size and balloon dilation time. Risk of bias was assessed using the Cochrane ROB-2 tool, and the certainty of evidence was evaluated using the GRADE approach.
resultsSeventeen RCTs with 2671 patients were included. ESBD significantly improved first-session stone clearance (RR 1.11; 95% CI: 1.04 to 1.17; P = 0.001), reduced ML use (RR 0.47; 95% CI: 0.34-0.65; P < 0.0001), and shortened procedure time (MD - 3.44 min; 95% CI: - 5.71 to - 1.17; P = 0.003) compared with ES alone. Total stone clearance was similar between groups. ESBD significantly reduced postoperative hemorrhage (RR 0.55; 95% CI 0.34 to 0.90; P = 0.02) and stone recurrence (RR 0.53; 95% CI 0.32 to 0.87; P = 0.01), with no difference in pancreatitis or other complications. ESBD significantly increases first-session stone removal and decreases ML use in both small- and large-stone-sized groups.
conclusionCurrent low- to very-low-certainty evidence suggests possible procedural advantages of ESBD over ES alone, including higher first-session stone clearance, reduced mechanical lithotripsy use, shorter procedure time, and lower rates of bleeding and stone recurrence, across both large and small CBD stones. These findings are hypothesis-generating and should not be considered practice-changing until confirmed by high-quality randomized controlled trials (RCTs).
Indexed as
Identifiers
42472408What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.