ReviewIs Endoscopic Balloon Dilation Still Associated With Higher Rates of Pancreatitis? A Systematic Review and Meta-AnalysisMatsubayashi, Carolina Ogawa MD*; Ribeiro, Igor Braga MD*; de Moura, Diogo Turiani Hourneaux MD, MSc, PhD*,†; Brunaldi, Vitor Ottoboni MD*; Bernardo, Wanderley Marques MD, PhD*; Hathorn, Kelly E. MD†; de Moura, Eduardo Guimarães Hourneaux PhD*Author Information From the *Gastrointestinal Endoscopy Unit, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil †Division of Gastroenterology, Hepatology and Endoscopy Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Received for publication July 27, 2019; accepted December 18, 2019. Address correspondence to: Igor Braga Ribeiro, MD, Academic Research, Gastrointestinal Endoscopy Unit, Department of Gastroenterology, University of São Paulo School of Medicine, R. Dr. Ovídio Pires de Campos, 255-Cerqueira César, São Paulo 05403-010, Brazil (e-mail: firstname.lastname@example.org). The authors declare no conflict of interest. Pancreas: February 2020 - Volume 49 - Issue 2 - p 158-174 doi: 10.1097/MPA.0000000000001489 Buy Metrics Abstract The objective of this study was to compare the efficacy and safety of endoscopic papillary balloon dilation (EPBD), endoscopic sphincterotomy (ES), and the combination of large balloon dilation and ES (ES + EPLBD) in the treatment of common bile duct stones, with a special focus on postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Individualized search strategies were developed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included randomized controlled trials (RCTs) which evaluated at least one of the following outcomes: PEP, complete stone removal in the first ERCP, need for mechanical lithotripsy, recurrence of common bile duct stones, bleeding, and cholangitis. Twenty-five RCTs were selected for analysis. Pancreatitis rates were higher for EPBD than for ES (P = 0.003), as were severe pancreatitis rates (P = 0.04). However, in the 10-mm or greater balloon subgroup analysis, this difference was not shown (P = 0.82). Rates of PEP were higher in the subgroup of non-Asian subjects (P = 0.02), and the results were not robust when RCTs that used endoscopic nasobiliary drainage were omitted. The incidence of pancreatitis was comparable between EPLBD and ES + EPLBD. All 3 approaches were equally efficacious. Nevertheless, the results should be interpreted with caution, because pancreatitis is a multifactorial pathology, and RCTs can have limited generalizability. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.