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Double-balloon enteroscopy for diagnostic and therapeutic ERCP in patients with surgically altered gastrointestinal anatomy: a systematic review and meta-analysis

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Abstract

Background

Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered gastrointestinal anatomy is challenging. Double-balloon enteroscopy (DBE) has been shown to be safe and efficacious for ERCP in these patients but attempts to synthesize existing data are limited. The purpose of this study was to conduct a systematic review and meta-analysis to evaluate the safety and efficacy of DBE-ERCP in surgically altered anatomy.

Methods

We searched MEDLINE, EMBASE, and CENTRAL databases through March 2020 for studies that conducted DBE-ERCP in patients with surgically altered gastrointestinal anatomy. Primary outcomes were enteroscopic, diagnostic, and procedural success rates of DBE-ERCP. Secondary outcomes were adverse events after DBE-ERCP. Random effects meta-analysis of proportions was performed when appropriate. The Newcastle–Ottawa scale was used to evaluate risk of bias. Heterogeneity was assessed using the inconsistency (I2) statistic.

Results

24 studies involving 1523 patients were included. The pooled enteroscopic, diagnostic, and procedural success rates of DBE-ERCP were 90% (95% confidence interval (CI), 84–94%), 94% (95% CI 88–98%), and 93% (95% CI 88–97%). Adverse events were reported in 4% (95% CI 3–6%) of cases. Subgroup analysis of short-scope DBE-ERCP (< 200 cm) and long-scope DBE-ERCP (200 cm) did not demonstrate substantial difference in outcomes.

Conclusion

DBE is safe and efficacious for facilitating ERCP in patients with surgically altered gastrointestinal anatomy, but RCTs or comparative studies are required to clarify its role compared to other modalities in surgically altered anatomy.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Sama Anvari, Yung Lee, Nivedh Patro, Melissa Sam Soon, Aristithes G. Doumouras & Dennis Hong

  2. Centre for Minimal Access Surgery (CMAS), St. Joseph’s Healthcare, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada

    Aristithes G. Doumouras & Dennis Hong

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  1. Sama Anvari
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Correspondence to Dennis Hong.

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Dr. Sama Anvari, Dr. Yung Lee, Mr. Nivedh Patro, Ms. Melissa Sam Soon, Dr. Aristithes G. Doumouras, and Dr. Dennis Hong have no conflicts of interest or financial ties to disclose.

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Anvari, S., Lee, Y., Patro, N. et al. Double-balloon enteroscopy for diagnostic and therapeutic ERCP in patients with surgically altered gastrointestinal anatomy: a systematic review and meta-analysis. Surg Endosc 35, 18–36 (2021). https://doi.org/10.1007/s00464-020-07893-x

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