Systematic review and meta-analysis of single-balloon enteroscopy-assisted ERCP in patients with surgically altered GI anatomy

Publication Date

2015

Journal Title

Gastrointest Endosc

Abstract

Background: Surgically altered pancreaticobiliary anatomy increases the difficulty of performing ERCP. Single-balloon enteroscopy (SBE) is a relatively new technique that can be used for ERCP in patients with surgically altered anatomy. Objective: To evaluate the therapeutic and diagnostic success of SBE-ERCP among patients with surgically altered anatomy. Design/Setting: Systematic review and meta-analysis of studies involving SBE-ERCP in patients with Roux-en-Y gastric bypass, hepaticojejunostomy, or Whipple procedure. Enteroscopy success was defined as success in reaching the papilla and/or biliary anastomosis by using SBE. Diagnostic success was defined as obtaining a cholangiogram. Procedural success was defined as the ability to provide successful intervention, if appropriate. A random-effects model was used. Results: A total of 461 patients underwent SBE-ERCP from 15 trials. The pooled enteroscopy, diagnostic, and procedural success rates were 80.9% (95% confidence interval [CI], 75.3%-86.4%), 69.4% (95% CI, 61.0%-77.9%), and 61.7% (95% CI, 52.9%-70.5%), respectively. There was statistical large heterogeneity for enteroscopy, diagnostic, and therapeutic success (P < .001 for all). Adverse events occurred in 6.5% (95% CI, 4.7%-9.1%) of patients. There was no evidence of publication bias in this meta-analysis. Limitations: Our findings and interpretations are limited by the quantity and heterogeneity of the studies included in the analysis. Conclusion: SBE-ERCP has high diagnostic and procedural success rates in this challenging patient population. It should be considered a first-line intervention when biliary access is required after Roux-en-Y gastric bypass, hepaticojejunostomy, or Whipple procedure.

Volume Number

82

Issue Number

1

Pages

9-19

Document Type

Article

EPub Date

2015/04/30

Status

Faculty, Northwell Researcher

Facility

School of Medicine; Northwell Health

Primary Department

Gastroenterology

PMID

25922248

DOI

10.1016/j.gie.2015.02.013

For the public and Northwell Health campuses

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