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

• Published in: Gastrointestinal endoscopy 2015-07, Vol.82 (1), p.9-19
• Main Authors: Inamdar, Sumant, MD, MPH, Slattery, Eoin, MD, MRCPI, Sejpal, Divyesh V., MD, Miller, Larry S., MD, Pleskow, Douglas K., MD, Berzin, Tyler M., MD, Trindade, Arvind J., MD
• Format: Article
• Language: English
• Subjects: Anastomosis, Surgical; Bile Ducts - anatomy & histology; Bile Ducts - surgery; Cholangiopancreatography, Endoscopic Retrograde - instrumentation; Cholangiopancreatography, Endoscopic Retrograde - methods; Gastric Bypass; Gastroenterology and Hepatology; Humans; Jejunum - anatomy & histology; Jejunum - surgery; Liver - anatomy & histology; Liver - surgery; Models, Statistical; Pancreaticoduodenectomy
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2015.02.013

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.