Comparison of Minimal Endoscopic Sphincterotomy with Balloon Dilation and Endoscopic Sphincterotomy for the Treatment of Small Common Bile Duct Stones: A Propensity-Matched Analysis.

BACKGROUND

Endoscopic sphincterotomy (ES) with balloon dilation, combining minimal incision and controlled dilation (ESBD), has been proposed to balance safety and efficacy in treating small common bile duct (CBD) stones. This study aimed to compare the outcomes of ESBD and conventional ES in a large real-world cohort.

METHODS

This retrospective study included 1,647 eligible patients (ESBD, n = 326; ES, n = 1,321) with ≤ 11 mm CBD stones who underwent endoscopic removal. Propensity score matching was performed (1:1, caliper 0.2), with 299 patients per group. The primary outcome was the rate of procedure-related adverse events (AEs), and secondary outcomes included complete stone removal, need for multiple sessions, use of lithotripsy, and procedure time for stone removal.

RESULTS

The AE rate was significantly lower in the ESBD group than in the ES group (4.0% vs. 8.7%, p = 0.028), particularly for bleeding (2.0% vs. 5.7%, p = 0.031). The incidence of pancreatitis was comparable between the groups. The procedure time for stone removal was significantly shorter in the ESBD group (median, 12 vs. 22 min; p < 0.001). The rates of complete stone removal, need for multiple sessions, and lithotripsy were similar between the groups. Multivariate analysis revealed that ESBD was significantly associated with a lower incidence of AEs (odds ratio, 0.43; p = 0.048).

CONCLUSIONS

ESBD significantly reduced bleeding and overall AEs without increasing the risk of pancreatitis while shortening the procedure time for stone removal. These findings support ESBD as a potentially safe, efficient, and practical alternative to conventional ES for removing small CBD stones.