Performance of short type double balloon enteroscope in endoscopic retrograde cholangiopancreatography: does the length of a scope matter?—a systematic review and meta-analysis

Xiao-Dong Shao, Xing-Shun Qi, Ran Wang, Xiao-Zhong Guo

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with previous surgery and reconstruction of gastrointestinal tract is often challenging. Numerous reports of ERCP with short type double balloon enteroscope (DBE) in patients with surgically altered anatomy have been published since 2009 and reported overall ERCP success rates varying widely. The aim of this study was to evaluate the efficacy and safety of ERCP with short type DBE in patients with surgically altered anatomy in a systematic review and meta-analysis.
Methods: A comprehensive literature search was conducted on PubMed, EMBASE, and Cochrane Library covering the period from January 2001 to December 2018. The following end points were analyzed: enteroscopy success rate, diagnostic ERCP success rate, therapeutic ERCP success rate, overall ERCP success rate, and complications. Data were selected and abstracted from eligible studies and were pooled using a random-effects model. Heterogeneity was assessed using the I2 test.
Results: Nine studies involving a total of 1,054 procedures in 890 patients were included in the analysis. The pooled enteroscopy, diagnostic, therapeutic, and overall ERCP success rates were 94.3% [95% confidence interval (CI): 88.9–98.0%], 94.3% (95% CI: 90.8–97.1%), 98.3% (95% CI: 95.5–99.7%) and 85.6% (95% CI: 78.7–91.3%), respectively. Among patients who underwent Roux-en-Y reconstruction, the overall ERCP success rate was 83.8% (95% CI: 75.3–90.8%). In patients who had undergone a pancreatoduodenectomy (PD), the overall ERCP success rate was 92.2% (95% CI: 79.8–99.0%). In patients with Billroth II gastrectomy, the overall ERCP success rate was 92.9% (95% CI: 84.0–98.4%). ERCP with short type DBE-related complications occurred in 38 patients including pancreatitis, perforation, cholangitis, bleeding, and liver graft ischemia. The incidence of ERCP with short type DBE -related complication was 3.8% (95% CI: 2.4–5.5%).
Conclusions: Diagnostic and therapeutic ERCP with short type DBE are feasible in patients with altered gastrointestinal anatomy with satisfactory success rate and acceptable complication rate. ERCP with short type DBE may be considered when pancreaticobiliary diseases occur in patients undergoing reconstruction of gastrointestinal tract.