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


METHODS
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.


CONCLUSIONS
Our findings and interpretations are limited by the quantity and heterogeneity of the studies included in the analysis.


CONCLUSIONS
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.
Department of Medicine, Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York, USA.
Sumant
S
Inamdar
Department of Preventive Medicine and Nutrition, Columbia University Medical Center, New York, New York, USA.
Eoin
E
Slattery
Department of Medicine, Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York, USA.
Divyesh V
DV
Sejpal
Department of Medicine, Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York, USA.
Larry S
LS
Miller
The Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Douglas K
DK
Pleskow
The Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Tyler M
TM
Berzin
Department of Medicine, Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York, USA; The Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Arvind J
AJ
Trindade
D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000033:anatomy & histology / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation / Q000379:methods*; D015390:Gastric Bypass; D006801:Humans; D007583:Jejunum / Q000033:anatomy & histology / Q000601:surgery*; D008099:Liver / Q000033:anatomy & histology / Q000601:surgery*; D015233:Models, Statistical; D016577:Pancreaticoduodenectomy