The effect of duration time on the efficacy and safety during endoscopic papillary balloon dilation for choledocholithiasis treatment

Background Endoscopic papillary balloon dilation (EPBD) has been widely accepted as an alternative to endoscopic sphincterotomy (EST) during therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis treatment. No consensus has been established to define the precise duration of EPBD. Methods The PubMed, EMBASE, Cochrane Library database were systematically searched up to 31 May 2019 for research comparing short duration (≤ 30 seconds) and long duration (≥ 1 minute) of EPBD. Results Seven studies demonstrated that EPBD with long duration was superior than short duration in the stone clearance rate during the first ERCP (OR 0.61, 95%CI [0.48, 0.77], P < 0.001). Long duration exhibited a trend of higher efficacy in total stone removal across all ERCP sessions (OR 0.98, 95%CI [0.73, 1.31], P = 0.89), less frequency of mechanical lithotripsy use (OR 1.22, 95%CI [0.79, 1.89], P = 0.37). Compared with long duration, short balloon time had lower rate of overall complications (OR 0.85, 95%CI [0.70, 1.04], P = 0.11) and post-ERCP pancreatitis (OR 0.81, 95%CI [0.63, 1.03], P = 0.09). No significance was identified in hemorrhage (OR 0.86, 95%CI [0.30, 2.44], P = 0.77), perforation (OR 0.54, 95%CI [0.14, 2.14], P = 0.38) and cholangitis (OR 1.15, 95%CI [0.80, 1.66], P = 0.44). Conclusion Long duration (≥ 1 minute) could significantly increase the efficacy of EPBD in stone removal rate during first ERCP session, manifesting higher rate of total CBD stone clearance and less mechanical lithotripsy. Short EPBD contributed to less overall complications than long EPBD but not significantly.