Sumant Inamdar1, Eoin Slattery2, Divyesh V Sejpal1, Larry S Miller1, Douglas K Pleskow3, Tyler M Berzin3, Arvind J Trindade4. 1. Department of Medicine, Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York, USA. 2. Department of Preventive Medicine and Nutrition, Columbia University Medical Center, New York, New York, USA. 3. The Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. 4. 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.
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.
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.
Authors: Tarek Sawas; Andrew C Storm; Fateh Bazerbachi; Chad J Fleming; Eric J Vargas; Vinay Chandrasekhara; James C Andrews; Michael J Levy; John A Martin; Bret T Petersen; Mark D Topazian; Barham K Abu Dayyeh Journal: Surg Endosc Date: 2019-05-28 Impact factor: 4.584