Status of single‐balloon enteroscopy‐assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: Systematic review and meta‐analysis on biliary interventions

Abstract

Background and Aims: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is still challenging. Usefulness of single-balloon enteroscopy (SBE)-assisted ERCP has been increasingly reported. Short SBE is considered beneficial with a 152-cm working length and a 3.2-mm working channel. This has increased the variety of devices that can be used during ERCP procedures. The aim of this pooled analysis was to evaluate the efficacy of SBE-assisted ERCP in patients with surgically altered anatomy and elucidate the current status.Methods: This systematic review only involved biliary interventions which excluded pancreatic cases. Studies involving SBE-assisted ERCP in patients with Roux-en-Y gastrectomy, hepaticojejunostomy with Roux-en-Y, pancreaticoduodenectomy (Whipple or Child procedure), or Billroth II gastrectomy were analyzed. Enteroscopy, biliary cannulation, and procedural success were assessed by pooling data in a random-effect model, according to the degree of heterogeneity, to obtain a proportion with 95% confidence interval (CI). The outcomes observed for conventional and short SBE cases were also reported.Results: Overall, 1227 SBE-assisted ERCP procedures from 21 studies were included. The pooled enteroscopy, biliary cannulation, and procedural success rates were 86.6% (95% CI, 82.4-90.3%), 90% (95% CI, 87.1-92.5%), and 75.8% (95% CI, 71.0-80.3%), respectively. Adverse events occurred in 6.6% (95% CI, 5.3-8.2%) of the procedures. Although good outcomes were reported for short SBE-assisted ERCP, these should not be directly compared to the outcomes observed for conventional SBE, as they assume different backgrounds and include confounding variables.Conclusions: Single-balloon enteroscopy-assisted ERCP in patients with surgically altered anatomy on biliary interventions is effective.

Current Status of Endoscopic Biliary Drainage in Patients with Distal Malignant Biliary Obstruction

“…Endoscopic retrograde cholangiopancreatography-related procedures have been reported to be successful in approximately 95% of cases [ 10 , 58 ]. However, it is sometimes difficult to complete the procedure in many situations, such as difficult biliary cannulation and surgically altered anatomy [ 59 , 60 ]. Moreover, distal malignant biliary obstruction could cause duodenal obstruction due to invasion; therefore, it is impossible to reach the papilla in such a situation.…”

Recent Advances of Interventional Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound for Patients with Surgically Altered Anatomy

“…The latest systematic review and meta-analysis reported that the pooled data reaching the target site, biliary cannulation, and procedural success rates were 86.6%, 90%, and 75.8%. Adverse events occurred in 6.6% of the procedures [23]. Fatal pancreatitis and intestinal perforation requiring surgical operation were included in the report.…”

How to access the common bile duct

“…In these cases, device-assisted enteroscopes are usually necessary [25] . Access to the entero-enteric anastomosis is usually straightforward, avoiding the passage of the stomach and ligament of Treitz.…”