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Surgical Endoscopy

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01-01-2021 | Endoscopy | Review Article

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

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

Published in: Surgical Endoscopy | Issue 1/2021

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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Ross AS (2009) Endoscopic retrograde cholangiopancreatography in the surgically modified gastrointestinal tract. Gastrointest Endosc Clin N Am 19:497–507. https://doi.org/10.1016/j.giec.2009.04.009CrossRefPubMed

Samuel I, Mason EE, Renquist KE, Huang Y-H, Zimmerman MB, Jamal M (2006) Bariatric surgery trends: an 18-year report from the International Bariatric Surgery Registry. Am J Surg 192:657–662. https://doi.org/10.1016/J.AMJSURG.2006.07.006CrossRefPubMed

Haber GB (2007) Double balloon endoscopy for pancreatic and biliary access in altered anatomy (with videos). Gastrointest Endosc 66:S47–S50. https://doi.org/10.1016/j.gie.2007.06.017CrossRefPubMed

Wright BE, Cass OW, Freeman ML (2002) ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc 56:225–232. https://doi.org/10.1016/S0016-5107(02)70182-XCrossRefPubMed

Dellon ES, Kohn GP, Morgan DR, Grimm IS (2009) Endoscopic retrograde cholangiopancreatography with single-balloon enteroscopy is feasible in patients with a prior Roux-en-Y anastomosis. Dig Dis Sci 54:1798–1803. https://doi.org/10.1007/s10620-008-0538-xCrossRefPubMed

Martinez J, Guerrero L, Byers P, Lopez P, Scagnelli T, Azuaje R, Dunkin B (2006) Endoscopic retrograde cholangiopancreatography and gastroduodenoscopy after Roux-en-Y gastric bypass. Surg Endosc 20:1548–1550. https://doi.org/10.1007/s00464-005-0267-6CrossRefPubMed

Mutignani M, Marchese M, Tringali A, Tacchino RM, Matera D, Foco M, Greco F, Costamagna G (2007) Laparoscopy-assisted ERCP after biliopancreatic diversion. Obes Surg 17:251–254. https://doi.org/10.1007/s11695-007-9026-1CrossRefPubMed

Shah RJ, Smolkin M, Yen R, Ross A, Kozarek RA, Howell DA, Bakis G, Jonnalagadda SS, Al-Lehibi AA, Hardy A, Morgan DR, Sethi A, Stevens PD, Akerman PA, Thakkar SJ, Brauer BC (2013) A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtube-assisted enteroscopy ERCP in patients with surgically altered pancreaticobiliary anatomy (with video). Gastrointest Endosc 77:593–600. https://doi.org/10.1016/j.gie.2012.10.015CrossRefPubMed

De Koning M, Moreels TG (2016) Comparison of double-balloon and single-balloon enteroscope for therapeutic endoscopic retrograde cholangiography after Roux-en-Y small bowel surgery. BMC Gastroenterol 16:98. https://doi.org/10.1186/s12876-016-0512-6CrossRefPubMedPubMedCentral

10.

Inamdar S, Slattery E, Sejpal DV, Miller LS, Pleskow DK, Berzin TM, Trindade AJ (2015) Systematic review and meta-analysis of single-balloon enteroscopy-assisted ERCP in patients with surgically altered GI anatomy. Gastrointest Endosc 82:9–19. https://doi.org/10.1016/j.gie.2015.02.013CrossRefPubMed

11.

Raithel M, Dormann H, Naegel A, Boxberger F, Hahn EG, Neurath MF, Maiss J (2011) Double-balloon-enteroscopy-based endoscopic retrograde cholangiopancreatography in post-surgical patients. World J Gastroenterol 17:2302–2314. https://doi.org/10.3748/wjg.v17.i18.2302CrossRefPubMedPubMedCentral

12.

Moreels TG, Hubens GJ, Ysebaert DK, Op de Beeck B, Pelckmans PA (2009) Diagnostic and therapeutic double-balloon enteroscopy after small bowel Roux-en-Y reconstructive surgery. Digestion 80:141–147. https://doi.org/10.1159/000212074CrossRefPubMed

13.

Siddiqui AA, Chaaya A, Shelton C, Marmion J, Kowalski TE, Loren DE, Heller SJ, Haluszka O, Adler DG, Tokar JL (2013) Utility of the short double-balloon enteroscope to perform pancreaticobiliary interventions in patients with surgically altered anatomy in a US multicenter study. Dig Dis Sci 58:858–864. https://doi.org/10.1007/s10620-012-2385-zCrossRefPubMed

14.

Yamamoto H, Sekine Y, Sato Y, Higashizawa T, Miyata T, Iino S, Ido K, Sugano K (2001) Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 53:216–220CrossRef

15.

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. https://doi.org/10.1136/bmj.b2535CrossRef

16.

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 41:849–854. https://doi.org/10.1055/s-0029-1215108CrossRefPubMed

17.

Tsutsumi K, Kato H, Muro S, Yamamoto N, Noma Y, Horiguchi S, Harada R, Okada H, Yamamoto K (2015) ERCP using a short double-balloon enteroscope in patients with prior pancreatoduodenectomy: higher maneuverability supplied by the efferent-limb route. Surg Endosc 29:1944–1951. https://doi.org/10.1007/s00464-014-3889-8CrossRefPubMed

18.

Kashani A, Abboud G, Lo S, Jamil L (2018) Double balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in Roux-en-Y gastric bypass anatomy: expert vs. novice experience. Endosc Int Open 06:E885–E891. https://doi.org/10.1055/a-0599-6059CrossRef

19.

Yamada A, Kogure H, Nakai Y, Takahara N, Mizuno S, Tada M, Koike K (2019) Performance of a new short-type double-balloon endoscope with advanced force transmission and adaptive bending for pancreaticobiliary intervention in patients with surgically altered anatomy: a propensity-matched analysis. Dig Endosc 31:86–93. https://doi.org/10.1111/den.13261CrossRefPubMed

20.

Aabakken L, Bretthauer M, Line PD (2007) Double-balloon enteroscopy for endoscopic retrograde cholangiography in patients with a Roux-en-Y anastomosis. Endoscopy 39:1068–1071. https://doi.org/10.1055/s-2007-966841CrossRefPubMed

21.

Emmett DS, Mallat DB (2007) Double-balloon ERCP in patients who have undergone Roux-en-Y surgery: a case series. Gastrointest Endosc 66:1038–1041. https://doi.org/10.1016/j.gie.2007.06.056CrossRefPubMed

22.

Cho S, Kamalaporn P, Kandel G, Kortan P, Marcon N, May G (2011) “Short” double-balloon enteroscope endoscopic retrograde cholangiopancreatography in patients with a surgically altered upper gastrointestinal tract. Can J Gastroenterol 25:615–619CrossRef

23.

Varabei A, Arlouski Y, Vizhinis E, Shuleika A, Lagodich N, Derkacheva N (2014) The use of double balloon enteroscopy for diagnosis and treatment of strictures of hepaticojejunal anastomoses after primary correction of bile duct injuries. Wideochirurgia I Inne Tech Maloinwazyjne 9:219–225. https://doi.org/10.5114/wiitm.2014.41635CrossRef

24.

Itokawa F, Itoi T, Ishii K, Sofuni A, Moriyasu F (2014) Single- and double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y plus hepaticojejunostomy anastomosis and Whipple resection. Dig Endosc 26:136–143. https://doi.org/10.1111/den.12254CrossRefPubMed

25.

May A, Färber M, Aschmoneit I, Pohl J, Manner H, Lotterer E, Möschler O, Kunz J, Gossner L, Mönkemüller K, Ell C (2010) Prospective multicenter trial comparing push-and-pull enteroscopy with the single- and double-balloon techniques in patients with small-bowel disorders. Am J Gastroenterol 105:575–581. https://doi.org/10.1038/ajg.2009.712CrossRefPubMed

26.

Takano N, Yamada A, Watabe H, Togo G, Yamaji Y, Yoshida H, Kawabe T, Omata M, Koike K (2011) Single-balloon versus double-balloon endoscopy for achieving total enteroscopy: a randomized, controlled trial. Gastrointest Endosc 73:734–739. https://doi.org/10.1016/j.gie.2010.10.047CrossRefPubMed

27.

Moreels TG (2014) Endoscopic retrograde cholangiopancreatography in patients with altered anatomy: How to deal with the challenges? World J Gastrointest Endosc 6:345. https://doi.org/10.4253/wjge.v6.i8.345CrossRefPubMedPubMedCentral

28.

Kogure H, Watabe H, Yamada A, Isayama H, Yamaji Y, Itoi T, Koike K (2011) Spiral enteroscopy for therapeutic ERCP in patients with surgically altered anatomy: actual technique and review of the literature. J Hepatobiliary Pancreat Sci 18:375–379. https://doi.org/10.1007/s00534-010-0357-2CrossRefPubMed

29.

Lopes TL, Clements RH, Wilcox CM (2009) Laparoscopy-assisted ERCP: experience of a high-volume bariatric surgery center (with video). Gastrointest Endosc 70:1254–1259. https://doi.org/10.1016/j.gie.2009.07.035CrossRefPubMed

30.

Schreiner MA, Chang L, Gluck M, Irani S, Gan SI, Brandabur JJ, Thirlby R, Moonka R, Kozarek RA, Ross AS (2012) Laparoscopy–assisted versus balloon enteroscopy–assisted ERCP in bariatric post–Roux-en-Y gastric bypass patients. Gastrointest Endosc 75:748–756. https://doi.org/10.1016/j.gie.2011.11.019CrossRefPubMed

31.

Choi EK, Chiorean MV, Coté GA, El HI, Ballard D, Fogel EL, Watkins JL, McHenry L, Sherman S, Lehman GA, Lehman GA (2013) ERCP via gastrostomy vs. double balloon enteroscopy in patients with prior bariatric Roux-en-Y gastric bypass surgery. Surg Endosc 27:2894–2899. https://doi.org/10.1007/s00464-013-2850-6CrossRefPubMed

32.

Testoni PA, Mariani A, Aabakken L, Arvanitakis M, Bories E, Costamagna G, Devière J, Dinis-Ribeiro M, Dumonceau JM, Giovannini M, Gyokeres T, Hafner M, Halttunen J, Hassan C, Lopes L, Papanikolaou IS, Tham TC, Tringali A, Van Hooft J, Williams EJ (2016) Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 48:657–683. https://doi.org/10.1055/s-0042-108641CrossRefPubMed

33.

Nakai Y, Kogure H, Yamada A, Isayama H, Koike K (2018) Endoscopic management of bile duct stones in patients with surgically altered anatomy. Dig Endosc 30:67–74. https://doi.org/10.1111/den.13022CrossRefPubMed

34.

Shimatani M, Takaoka M, Tokuhara M, Miyoshi H, Ikeura T, Okazaki K (2015) Review of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography using several endoscopic methods in patients with surgically altered gastrointestinal anatomy. World J Gastrointest Endosc 7:617–627. https://doi.org/10.4253/wjge.v7.i6.617CrossRefPubMedPubMedCentral

35.

Huibregtse K (1996) Complications of endoscopic sphincterotomy and their prevention. N Engl J Med 335:961–963. https://doi.org/10.1056/NEJM199609263351309CrossRefPubMed

36.

Moreels TG (2013) ERCP in the patient with surgically altered anatomy. Curr Gastroenterol Rep. https://doi.org/10.1007/s11894-013-0343-3CrossRefPubMed

37.

Kato H, Tsutsumi K, Harada R, Okada H, Yamamoto K (2014) Short double-balloon enteroscopy is feasible and effective for endoscopic retrograde cholangiopancreatography in patients with surgically altered gastrointestinal anatomy. Dig Endosc 26:130–135. https://doi.org/10.1111/den.12251CrossRefPubMed

38.

Moreels TG (2018) Update in enteroscopy: new devices and new indications. Dig Endosc 30:174–181. https://doi.org/10.1111/den.12920CrossRefPubMed

39.

Law R, Wong Kee Song LM, Petersen BT, Baron TH (2013) Single-session ERCP in patients with previous Roux-en-Y gastric bypass using percutaneous-assisted transprosthetic endoscopic therapy: a case series. Endoscopy 45:671–675. https://doi.org/10.1055/s-0033-1344029CrossRefPubMed

40.

Yamauchi H, Kida M, Okuwaki K, Miyazawa S, Iwai T, Tokunaga S, Takezawa M, Imaizumi H, Koizumi W (2015) Passive-bending, short-type single-balloon enteroscope for endoscopic retrograde cholangiopancreatography in Roux-en-Y anastomosis patients. World J Gastroenterol 21:1546–1553. https://doi.org/10.3748/wjg.v21.i5.1546CrossRefPubMedPubMedCentral

41.

Trindade AJ, Mella JM, Slattery E, Cohen J, Dickstein J, Garud SS, Chuttani R, Pleskow DK, Sawhney MS, Berzin TM (2014) Use of a cap in single-balloon enteroscopy-assisted endoscopic retrograde cholangiography. Endoscopy 77:453–456. https://doi.org/10.1055/s-0034-1391077CrossRef

42.

Rahmi G, Vinet M-A, Perrod G, Saurin J-C, Samaha E, Ponchon T, Canard J-M, Edery J, Maoulida H, Chatellier G, Durand-Zaleski I, Cellier C (2017) Efficacy of double-balloon enteroscopy for small-bowel polypectomy: clinical and economic evaluation. Therap Adv Gastroenterol 10:465–472. https://doi.org/10.1177/1756283X17696232CrossRefPubMedPubMedCentral

43.

Teplick SK, Flick P, Brandon JC (1991) Transhepatic cholangiography in patients with suspected biliary disease and nondilated intrahepatic bile ducts. Gastrointest Radiol 16:193–197. https://doi.org/10.1007/BF01887344CrossRefPubMed

44.

Mehdizadeh S, Ross A, Gerson L, Leighton JA, Chen A, Schembre D, Chen G, Semrad C, Kamal A, Harrison EM, Binmoeller K, Waxman I, Kozarek R, Lo SK (2006) What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers. Gastrointest Endosc 64:740–750. https://doi.org/10.1016/J.GIE.2006.05.022CrossRefPubMed

45.

Skinner M, Popa D, Neumann H, Wilcox C, Mönkemüller K (2014) ERCP with the overtube-assisted enteroscopy technique: a systematic review. Endoscopy 46:560–572. https://doi.org/10.1055/s-0034-1365698CrossRefPubMed

Title: Double-balloon enteroscopy for diagnostic and therapeutic ERCP in patients with surgically altered gastrointestinal anatomy: a systematic review and meta-analysis
Authors: Sama Anvari
Yung Lee
Nivedh Patro
Melissa Sam Soon
Aristithes G. Doumouras
Dennis Hong
Publication date: 01-01-2021
Publisher: Springer US
Keywords: Endoscopy
Cholangitis
Endoscopic Retrograde Cholangiopancreatography
Published in: Surgical Endoscopy / Issue 1/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07893-x

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Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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