ArticleDigestive diseases and sciences2026
Papillary Balloon Dilation Versus Sphincterotomy for Small Common Bile Duct Stones: Recurrence and Pneumobilia in a Retrospective Cohort.
Article 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.
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Abstract
backgroundCommon bile duct stone (CBDS) recurrence remains a clinical concern after endoscopic stone clearance. Although both endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) are widely used, whether differences in papillary sphincter disruption influence long-term recurrence and pneumobilia remains uncertain.
aimTo compare long-term CBDS recurrence after EPBD versus EST and to explore the associations among sphincterotomy extent, pneumobilia, and recurrence.
methodsAdults with native papillae who underwent ERCP for CBDSs ≤10 mm at two centers from 2004 to 2024 were retrospectively analyzed. Patients treated with EST or EPBD alone who achieved complete stone clearance were included. The primary outcome was CBDS recurrence. Inverse probability of treatment weighting (IPTW), Cox regression, and propensity-score matching were used to adjust for confounding.
resultsAmong 4,848 screened, 1,119 were included (971 EST and 148 EPBD). Recurrence occurred in 151 EST patients (15.6%) and 12 EPBD patients (8.1%). In the primary weighted Cox model, EPBD was associated with a lower recurrence hazard (HR, 0.444; 95% CI, 0.239-0.825; P = 0.010). No significant difference in overall adverse events was observed after weighting (OR, 0.961; 95% CI, 0.602-1.536; P = 0.868). In the exploratory CT subgroup (n = 322), greater sphincter disruption was associated with pneumobilia (trend OR, 1.43; 95% CI, 1.12-1.82). Pneumobilia was associated with subsequent recurrence (HR, 2.66; 95% CI, 1.72-4.13).
conclusionsIn selected patients with CBDSs ≤10 mm, EPBD was associated with a lower long-term recurrence hazard than EST. No statistically significant between-group difference in ERCP-related adverse events was observed. In exploratory CT analyses, greater papillary sphincter disruption was associated with pneumobilia, and pneumobilia was associated with subsequent stone recurrence.
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