Endoscopic and percutaneous biliary interventions in patients with altered upper gastrointestinal anatomy—the Munich Multicenter Experience

Nennstiel, Simon; Freivogel, Kathrin; Faber, Alexander; Schlag, Christoph; Haller, Bernhard; Blöchinger, M; Dollhopf, Markus; Lewerenz, Björn; Schepp, Wolfgang; Schirra, Jörg; Schmid, Roland M.; Neu, Bruno

doi:10.1007/s00464-020-08191-2

Cited by 8 publications

(14 citation statements)

References 54 publications

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“…The initial literature search resulted in 4105 studies, with 76 of them [ 11 , 13 , 15 , 17 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 ,…”

Section: Resultsunclassified

“…All studies, but seven [ 41 , 46 , 68 , 70 , 71 , 72 , 78 ], were retrospective, and evaluated at least one technique. Sixteen studies [ 15 , 17 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 ] provided comparisons between two or more modalities. Fifty-five studies evaluated -EA-ERCP, including 53 with BA-ERCP [ 11 , 13 , 15 , 17 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ,…”

Section: Resultsmentioning

confidence: 99%

“…The pooled rate of technical success for EA-ERCP (55 studies, 2549 procedures) [ 11 , 13 , 15 , 17 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 92 , 93 , 95 , 96 , 97 , 98 , 101 , 102 , 103 ] was 87.3% [95%CI: 85.3–89.4] ( Figure 2 a). When focusing on the individual performance of different EA-ERCP modalities ( Supplementary Figure S1 ), SE-ERCP (4 s...…”

Section: Resultsmentioning

confidence: 99%

“…When focusing on the individual performance of different EA-ERCP modalities ( Supplementary Figure S1 ), SE-ERCP (4 studies, 170 procedures) [ 42 , 43 , 101 , 102 ] yielded a lower rate of technical success [70.3% (95%CI: 55.1–85.6)]. Moreover, single-balloon enteroscope-assisted ERCP (SBE) [ 15 , 33 , 34 , 35 , 36 , 37 , 38 , 40 , 45 , 48 , 50 , 53 , 54 , 59 , 62 , 63 , 64 , 66 , 68 , 71 , 72 , 92 , 93 , 95 , 101 , 102 , 103 ] (27 studies, 1543 procedures) provided optimal positioning in front of the ampulla and/or anastomosis in 88.1% (95%CI: 85.5–90.6) of cases and double-balloon enteroscope-assisted-ERCP (DBE) in 89.8% (95%CI: 87.1–92.4). Regarding EDGE (9 studies, 253 procedures) [ 77 , 81 , 82 , 86 , 87 , 94 , 97 , 99 , 100 ], the pooled rate of technical success was 97.9% (95%CI: 96.4–99.4); Figure 2 b), while sufficient positioning in front of the ampulla was possible in 99.1% (95%CI: 98.6–99.7); Figure 2 c) of the patients undergoing LA-ERCP (18 studies, 767 procedures) [ 48 , 74 , 75 , 76 ,…”

Section: Resultsmentioning

confidence: 99%

“…Currently, there is no definite recommendation regarding successful ERCP in patients with SAA. Conventional endoscopes, namely duodenoscopes, gastroscopes and colonoscopes have been proven suboptimal for ductal cannulation, particularly due to their inability to reach the ampulla or the anastomosis [ 10 , 15 , 16 ] More specifically, the conventional side-viewing duodenoscope, although represents an acceptable choice after Billroth II gastrectomies (62.5%- 86.1%), the success rate in approaching the ampulla reduces dramatically after more complex surgeries, such as RY (75.3%) or Whipple (57.9%) [ 15 , 17 ]. Further modifications, including the use of attachments, guidewires, dilatation balloons, or fluoroscopy guidance have provided positive outcomes in isolated cases, but remain inferior to advanced endoscopic techniques [ 9 , 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

Gkolfakis

Papaefthymiou

Facciorusso

et al. 2022

Life

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Background and Aims: Endoscopic retrograde cholangiopancreatography (ERCP), in surgically altered anatomy (SAA), can be challenging and the optimal technique selection remains debatable. Most common foregut interventions resulting to this burden consist of Billroth II gastrectomy, Whipple surgery and Roux-en-Y anastomoses, including gastric by-pass. This systematic review, with meta-analysis, aimed to compare the rates of successful enteroscope-assisted (EA)-, endosonography-directed transgastric- (EDGE), and laparoscopy-assisted (LA)-ERCP. Methods: A systematic research (Medline) was performed for relative studies, through January 2022. The primary outcome was technical success, defined as approaching the ampulla site. Secondary outcomes included the desired duct cannulation, successful therapeutic manipulations, and complication rates. We performed meta-analyses of pooled data, and subgroup analysis considering the EA-ERCP subtypes (spiral-, double and single balloon-enteroscope). Pooled rates are reported as percentages with 95% Confidence Intervals (95%CIs). Results: Seventy-six studies were included (3569 procedures). Regarding primary outcome, EA-ERCP was the least effective [87.3% (95%CI: 85.3–89.4); I2: 91.0%], whereas EDGE and LA-ERCP succeeded in 97.9% (95%CI: 96.4–99.4; I2: 0%) and 99.1% (95%CI: 98.6–99.7; I2: 0%), respectively. Similarly, duct cannulation and therapeutic success rates were 74.7% (95%CI: 71.3–78.0; I2: 86.9%) and 69.1% (95%CI: 65.3–72.9; I2: 91.8%) after EA-ERCP, 98% (95%CI: 96.5–99.6; I2: 0%) and 97.9% (95%CI: 96.3–99.4) after EDGE, and 98.6% (95%CI: 97.9–99.2; I2: 0%) and 98.5% (95%CI: 97.8–99.2; I2: 0%) after LA-ERCP, respectively. The noticed high heterogeneity in EA-ERCP results probably reflects the larger number of included studies, the different enteroscopy modalities and the variety of surgical interventions. Comparisons revealed the superiority of LA-ERCP and EDGE over EA-ERCP (p ≤ 0.001) for all success-related outcomes, though LA-ERCP and EDGE were comparable (p ≥ 0.43). ERCP with spiral-enteroscope was inferior to balloon-enteroscope, while the type of the balloon-enteroscope did not affect the results. Most adverse events were recorded after LA-ERCP [15.1% (95%CI: 9.40–20.8); I2: 87.1%], and EDGE [13.1% (95%CI: 7.50–18.8); I2: 48.2%], significantly differing from EA-ERCP [5.7% (95%CI: 4.50–6.80); p ≤ 0.04; I2: 64.2%]. Conclusions: LA-ERCP and EDGE were associated with higher technical, cannulation, and therapeutic success compared to EA-ERCP, though accompanied with more adverse events.

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