Abstract
Background
The forward-viewing endoscope has been increasingly used to perform endoscopic retrograde cholangiopancreatography (ERCP) in patients who underwent Billroth II gastrectomy. This study intended to assess efficacy and safety of the forward-viewing endoscope for ERCP in Billroth II gastrectomy patients compared with conventional side-viewing endoscope using a systematic review and meta-analysis.
Methods
A systematic review was conducted for studies that evaluated the outcomes of ERCP for patients with Billroth II gastrectomy. Random-effect model meta-analyses with subgroup analyses were conducted. The methodological quality of the included publications was evaluated using the risk of bias assessment tool for non-randomized studies. The publication bias was assessed.
Results
In total, 25 studies (1 randomized, 18 retrospective, 1 prospective, and 5 case series studies) with 2446 patients (499 forward-viewing and 1947 side-viewing endoscopes) were analyzed. The pooled afferent loop intubation rate was higher with the forward-viewing endoscope (90.3%, 95% confidence interval (CI) 85.6–93.6 vs. 86.8%, 95% CI 82.8–89.9%). The pooled selective cannulation rate was higher with the side-viewing endoscope (92.3%, 95% CI 88.0–95.2 vs. 91.1%, 95% CI 87.2–93.9%). The pooled bowel perforation rate was higher with the side-viewing endoscope (3.6%, 95% CI 2.3–5.7 vs. 3.0%, 95% CI 1.7–5.3%). The pooled pancreatitis rate was higher with the forward-viewing endoscope (5.4%, 95% CI 3.6–8.0 vs. 2.5%, 95% CI 2.3–5.7%). The pooled bleeding rate was higher with the forward-viewing endoscope (3.0%, 95% CI 1.6–5.5 vs. 2.0%, 95% CI 1.4–3.0%). The heterogeneity among the studies was not significant. The publication bias was minimal.
Conclusion
This meta-analysis indicates that the forward-viewing endoscope is as safe and effective as conventional side-viewing endoscope for ERCP in patients with Billroth II gastrectomy.
Similar content being viewed by others
Abbreviations
- ERCP:
-
Endoscopic retrograde cholangiopancreatography
- RoBANS:
-
Risk of bias assessment tool for non-randomized studies
- ROB:
-
Risk of bias
- CIs:
-
Confidence intervals
- EPBD:
-
Endoscopic papillary balloon dilation
- EST:
-
Endoscopic sphincterotomy
- EPLBD:
-
Endoscopic papillary large balloon dilation
- MRCP:
-
Magnetic resonance cholangiopancreatography
- A-loop:
-
Afferent loop
- NK:
-
Needle knife
References
Dickey W, Jacob S, Porter KG (1996) Balloon dilation of the papilla via a forward-viewing endoscope: an aid to therapeutic endoscopic retrograde cholangiopancreatography in patients with Billroth-II gastrectomy. Endoscopy 28(6):531–532. https://doi.org/10.1055/s-2007-1005547
Chu Y-C, Su S-J, Yang C-C, Yeh Y-H, Chen C-H, Yueh S-K (2007) ERCP plus papillotomy by use of double-balloon enteroscopy after Billroth II gastrectomy. Gastrointest Endosc 66(6):1234–1236. https://doi.org/10.1016/j.gie.2007.04.030
Bergman JJ, van Berkel AM, Bruno MJ, Fockens P, Rauws EA, Tijssen JG, Tytgat GN, Huibregtse K (2001) A randomized trial of endoscopic balloon dilation and endoscopic sphincterotomy for removal of bile duct stones in patients with a prior Billroth II gastrectomy. Gastrointest Endosc 53(1):19–26
Itoi T, Ishii K, Itokawa F, Kurihara T, Sofuni A (2010) Large balloon papillary dilation for removal of bile duct stones in patients who have undergone a billroth ii gastrectomy. Dig Endosc 22(Suppl 1):S98-S102
Costamagna G, Mutignani M, Perri V, Gabrielli A, Locicero P, Crucitti F (1994) Diagnostic and therapeutic ERCP in patients with Billroth II gastrectomy. Acta Gastroenterol Belg 57(2):155–162
Kim GH, Kang DH, Song GA, Heo J, Park CH, Ha TI, Kim KY, Lee HJ, Kim ID, Choi SH, Song CS (2008) Endoscopic removal of bile-duct stones by using a rotatable papillotome and a large-balloon dilator in patients with a Billroth II gastrectomy (with video). Gastrointest Endosc 67(7):1134–1138
Lee YT (2004) Cap-assisted endoscopic retrograde cholangiopancreatography in a patient with a Billroth II gastrectomy. Endoscopy 36(7):666. https://doi.org/10.1055/s-2004-814558
Waye JD, Yessayan SA, Lewis BS, Fabry TL (1991) The technique of abdominal pressure in total colonoscopy. Gastrointest Endosc 37(2):147–151
Byun JW, Kim JW, Sung SY, Jung HY, Jeon HK, Park HJ, Kim MY, Kim HS, Baik SK (2012) Usefulness of forward-viewing endoscope for endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrectomy. Clin Endosc 45(4):397–403. https://doi.org/10.5946/ce.2012.45.4.397
Jang JS, Lee S, Lee HS, Yeon MH, Han JH, Yoon SM, Chae HB, Youn SJ, Park SM (2015) Efficacy and safety of endoscopic papillary balloon dilation using cap-fitted forward-viewing endoscope in patients who underwent Billroth II gastrectomy. Clin Endosc 48(5):421–427. https://doi.org/10.5946/ce.2015.48.5.421
Park TY, Kang JS, Song TJ, Lee SS, Lee H, Choi JS, Kim HJ, Jang JW (2016) Outcomes of ERCP in Billroth II gastrectomy patients. Gastrointest Endosc 83(6):1193–1201. https://doi.org/10.1016/j.gie.2015.10.036
Kim SY, Park JE, Lee YJ, Seo HJ, Sheen SS, Hahn S, Jang BH, Son HJ (2013) Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. J Clin Epidemiol 66(4):408–414. https://doi.org/10.1016/j.jclinepi.2012.09.016
Higgins JP, Green S (2013) Cochrane handbook for systemic reviews of interventions. Version 5.1.0. The Cochrane Collaboration: 2011
Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558. https://doi.org/10.1002/sim.1186
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. https://doi.org/10.1136/bmj.327.7414.557
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188
Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56(2):455–463
Sutton AJAK., Jones DR, Sheldon TA, Song F (2000) Methods for meta-analysis in medical research. Wiley, Chichester
Sterne JA, Egger M (2001) Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 54(10):1046–1055
Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634
Wang F, Xu B, Li Q, Zhang X, Jiang G, Ge X, Nie J, Zhang X, Wu P, Ji J, Miao L (2016) Endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: one single center’s experience. Medicine 95(52):e5743. https://doi.org/10.1097/md.0000000000005743
Ki HS, Park CH, Jun CH, Park SY, Kim HS, Choi SK, Rew JS (2015) Feasibility of cap-assisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy. Gut Liver 9(1):109–112. https://doi.org/10.5009/gnl13447
Aabakken L, Holthe B, Sandstad O, Rosseland A, Osnes M (1998) Endoscopic pancreaticobiliary procedures in patients with a Billroth II resection: a 10-year follow-up study. Ital J Gastroenterol Hepatol 30(3):301–305
Demarquay JF, Dumas R, Buckley MJ, Conio M, Zanaldi H, Hastier P, Caroli-Bosc FX, Delmont JP (1998) Endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrectomy. Ital J Gastroenterol Hepatol 30(3):297–300
Urakami Y, Seki H, Kishi S (1976) Endoscopic retrograde cholangiopancreatography after Billroth II operation and endoscopic sphincterotomy. GEN 30(3–4):251–254
Voorburg A, Fockens P, Rauws EA, Bruno M (2007) ERCP in patients with a Billroth II gastrectomy in a large tertiary referral center: frequency of procedures, complication rates and outcome. Gastrointest Endosc 65(5):AB215. https://doi.org/10.1016/j.gie.2007.03.445
Hintze RE, Veltzke W, Adler A, Abou-Rebyeh H (1997) Endoscopic sphincterotomy using an S-shaped sphincterotome in patients with a Billroth II or Roux-en-Y gastrojejunostomy. Endoscopy 29(2):74–78
Hintze RE, Adler A, Veltzke W, Abou-Rebyeh H (1997) Endoscopic access to the papilla of Vater for endoscopic retrograde cholangiopancreatography in patients with billroth II or Roux-en-Y gastrojejunostomy. Endoscopy 29(2):69–73. https://doi.org/10.1055/s-2007-1004077
Forbes A, Cotton PB (1984) ERCP and sphincterotomy after Billroth II gastrectomy. Gut 25(9):971–974
Osnes M, Rosseland AR, Aabakken L (1986) Endoscopic retrograde cholangiography and endoscopic papillotomy in patients with a previous Billroth-II resection. Gut 27(10):1193–1198
Kim MH, Lee SK, Lee MH, Myung SJ, Yoo BM, Seo DW, Min YI (1997) Endoscopic retrograde cholangiopancreatography and needle-knife sphincterotomy in patients with Billroth II gastrectomy: a comparative study of the forward-viewing endoscope and the side-viewing duodenoscope. Endoscopy 29(2):82–85. https://doi.org/10.1055/s-2007-1004080
Lin LF, Siauw CP, Ho KS, Tung JC (1999) ERCP in post-Billroth II gastrectomy patients: emphasis on technique. Am J Gastroenterol 94(1):144–148. https://doi.org/10.1111/j.1572-0241.1999.00785.x
Faylona JM, Qadir A, Chan AC, Lau JY, Chung SC (1999) Small-bowel perforations related to endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy. Endoscopy 31(7):546–549. https://doi.org/10.1055/s-1999-61
Swarnkar K, Stamatakis JD, Young WT (2005) Diagnostic and therapeutic endoscopic retrograde cholangiopancreaticography after Billroth II gastrectomy—safe provision in a district general hospital. Ann R Coll Surg Engl 87(4):274–276. https://doi.org/10.1308/1478708051865
Cicek B, Parlak E, Disibeyaz S, Koksal AS, Sahin B (2007) Endoscopic retrograde cholangiopancreatography in patients with Billroth II gastroenterostomy. J Gastroenterol Hepatol 22(8):1210–1213. https://doi.org/10.1111/j.1440-1746.2006.04765.x
Park CH, Lee WS, Joo YE, Kim HS, Choi SK, Rew JS (2007) Cap-assisted ERCP in patients with a Billroth II gastrectomy. Gastrointest Endosc 66(3):612–615
Dolay K, Soylu A (2008) Easy sphincterotomy in patients with Billroth II gastrectomy: a new technique. Turk J Gastroenterol 19(2):109–113
Swan MP, Donnellan F, Al-Quarshobi I, May GR, Haber GB, Kandel G, Marcon NE, Kortan PP (2010) T1574: Billroth II partial gastrectomy and ERCP outcomes: a 20-year experience and changing trends in management. Gastrointest Endosc 71(5):AB312. https://doi.org/10.1016/j.gie.2010.03.788
Lee TH, Hwang JC, Choi HJ, Moon JH, Cho YD, Yoo BM, Park SH, Kim JH, Kim SJ (2012) One-step transpapillary balloon dilation under cap-fitted endoscopy without a preceding sphincterotomy for the removal of bile duct stones in Billroth II gastrectomy. Gut Liver 6(1):113–117. https://doi.org/10.5009/gnl.2012.6.1.113
Choi CW, Choi JS, Kang DH, Kim BG, Kim HW, Park SB, Yoon KT, Cho M (2012) Endoscopic papillary large balloon dilation in Billroth II gastrectomy patients with bile duct stones. J Gastroenterol Hepatol 27(2):256–260. https://doi.org/10.1111/j.1440-1746.2011.06863.x
Kianicka B, Dite P, Piskac P (2012) Pitfalls of pancreatobiliary endoscopy after Billroth II gastrectomy. Hepatogastroenterology 59(113):17–21. https://doi.org/10.5754/hge10186
Jang HW, Lee KJ, Jung MJ, Jung JW, Park JY, Park SW, Song SY, Chung JB, Bang S (2013) Endoscopic papillary large balloon dilatation alone is safe and effective for the treatment of difficult choledocholithiasis in cases of Billroth II gastrectomy: a single center experience. Dig Dis Sci 58(6):1737–1743. https://doi.org/10.1007/s10620-013-2580-6
Park SB, Kim HW, Kang DH, Choi CW, Yoon KT, Cho M, Song BJ (2013) Sphincterotomy by triple lumen needle knife using guide wire in patients with Billroth II gastrectomy. World J Gastroenterol 19(48):9405–9409. https://doi.org/10.3748/wjg.v19.i48.9405
Kim KH, Kim TN (2014) Endoscopic papillary large balloon dilation for the retrieval of bile duct stones after prior Billroth II gastrectomy. Saudi J Gastroenterol 20(2):128–133. https://doi.org/10.4103/1319-3767.129478
Bove V, Tringali A, Familiari P, Gigante G, Boskoski I, Perri V, Mutignani M, Costamagna G (2015) ERCP in patients with prior Billroth II gastrectomy: report of 30 years’ experience. Endoscopy 47(7):611–616. https://doi.org/10.1055/s-0034-1391567
Wu WG, Mei JW, Zhao MN, Zhang WJ, Gu J, Tao YJ, Liu YB, Wang XF (2016) Use of the conventional side-viewing duodenoscope for successful endoscopic retrograde cholangiopancreatography in postgastrectomy patients. J Clin Gastroenterol 50(3):244–251. https://doi.org/10.1097/mcg.0000000000000442
Chu YC, Su SJ, Yang CC, Yeh YH, Chen CH, Yueh SK (2007) ERCP plus papillotomy by use of double-balloon enteroscopy after Billroth II gastrectomy. Gastrointest Endosc 66(6):1234–1236. https://doi.org/10.1016/j.gie.2007.04.030
Shimatani M, Matsushita M, Takaoka M, Koyabu M, Ikeura T, Kato K, Fukui T, Uchida K, Okazaki K (2009) Effective “short” double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy: a large case series. Endoscopy 41(10):849–854. https://doi.org/10.1055/s-0029-1215108
Itoi T, Ishii K, Sofuni A, Itokawa F, Tsuchiya T, Kurihara T, Tsuji S, Ikeuchi N, Umeda J, Moriyasu F (2010) Single-balloon enteroscopy-assisted ERCP in patients with Billroth II gastrectomy or Roux-en-Y anastomosis (with video). Am J Gastroenterol 105(1):93–99. https://doi.org/10.1038/ajg.2009.559
Yamauchi H, Kida M, Okuwaki K, Miyazawa S, Iwai T, Takezawa M, Kikuchi H, Watanabe M, Imaizumi H, Koizumi W (2013) Short-type single balloon enteroscope for endoscopic retrograde cholangiopancreatography with altered gastrointestinal anatomy. World J Gastroenterol 19(11):1728–1735. https://doi.org/10.3748/wjg.v19.i11.1728
Wagh MS, Draganov PV (2012) Prospective evaluation of spiral overtube-assisted ERCP in patients with surgically altered anatomy. Gastrointest Endosc 76(2):439–443. https://doi.org/10.1016/j.gie.2012.04.444
Koo HC, Moon JH, Choi HJ, Ko BM, Hong SJ, Cheon YK, Cho YD, Lee JS, Lee MS, Shim CS (2009) The utility of a multibending endoscope for selective cannulation during ERCP in patients with a Billroth II gastrectomy (with video). Gastrointest Endosc 69(4):931–934. https://doi.org/10.1016/j.gie.2008.10.053
Yao W, Huang Y, Chang H, Li K, Huang X (2013) Endoscopic retrograde cholangiopancreatography using a dual-lumen endogastroscope for patients with Billroth II gastrectomy. Gastroenterol Res Pract 2013:146867. https://doi.org/10.1155/2013/146867
Nakahara K, Okuse C, Suetani K, Morita R, Michikawa Y, Ozawa S, Hosoya K, Nomoto M, Kobayashi S, Otsubo T, Itoh F (2015) Endoscopic retrograde cholangiography using an anterior oblique-viewing endoscope in patients with altered gastrointestinal anatomy. Dig Dis Sci 60(4):944–950. https://doi.org/10.1007/s10620-014-3386-x
Elton E, Hanson BL, Qaseem T, Howell DA (1998) Diagnostic and therapeutic ERCP using an enteroscope and a pediatric colonoscope in long-limb surgical bypass patients. Gastrointest Endosc 47(1):62–67
Azeem N, Tabibian JH, Baron TH, Orhurhu V, Rosen CB, Petersen BT, Gostout CJ, Topazian MD, Levy MJ (2013) Use of a single-balloon enteroscope compared with variable-stiffness colonoscopes for endoscopic retrograde cholangiography in liver transplant patients with Roux-en-Y biliary anastomosis. Gastrointest Endosc 77(4):568–577. https://doi.org/10.1016/j.gie.2012.11.031
Easler JJ, Sherman S (2016) Cap-assisted pancreaticobiliary endoscopy in Billroth II anatomy: ERCP “through the looking glass”. Gastrointest Endosc 83(6):1202–1204. https://doi.org/10.1016/j.gie.2016.01.001
Disario JA, Freeman ML, Bjorkman DJ, Macmathuna P, Petersen BT, Jaffe PE, Morales TG, Hixson LJ, Sherman S, Lehman GA, Jamal MM, Al-Kawas FH, Khandelwal M, Moore JP, Derfus GA, Jamidar PA, Ramirez FC, Ryan ME, Woods KL, Carr-Locke DL, Alder SC (2004) Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology 127(5):1291–1299
Author information
Authors and Affiliations
Contributions
Study concept and design: TYP; acquisition of data: TYP, CSB, SHC, YJY, SPS; analysis of data: CSB; interpreting data: TYP, CSB, JHY, KTS, GHB, JHY; drafting manuscript: TYP, CSB; critical revision of manuscript: DJK.
Corresponding author
Ethics declarations
Disclosures
Drs. Tae Young Park, Chang Seok Bang, Sang Hyeon Choi, Young Joo Yang, Suk Pyo Shin, Ki Tae Suk, Gwang Ho Baik, Dong Joon Kim, and Jai Hoon Yoon have no conflicts of interest or financial ties to disclose.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Park, T.Y., Bang, C.S., Choi, S.H. et al. Forward-viewing endoscope for ERCP in patients with Billroth II gastrectomy: a systematic review and meta-analysis. Surg Endosc 32, 4598–4613 (2018). https://doi.org/10.1007/s00464-018-6213-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-018-6213-1