Overtube-assisted enteroscopy techniques have increased the ability to perform endoscopic retrograde cholangiopancreatography (ERCP) in patients with altered upper gastrointestinal anatomy, such as Roux-en-Y gastric bypass.
Dr Matthew Skinner and colleagues compared the efficacy and safety of overtube-assisted enteroscopy-ERCP in patients with different configurations of upper gastrointestinal anatomy.
A systematic review was performed following a literature search for papers published between 1966 and August 2013.
The team searched MEDLINE, Embase, Cochrane library, and Scopus.
The researchers analyzed diagnostic and therapeutic success rates, cannulation success rate, ERCP success rate, type of enteroscopy, types of intervention, complications.
A total of 23 relevant reports on overtube-assisted enteroscopy procedures, including single-balloon, double-balloon, and spiral enteroscopy, were analyzed.
|Overall ERCP success for all attempts was approximately 74%|
Studies included a total of 945 procedures in 679 patients who had a variety of postsurgical upper gastrointestinal anatomical configurations.
The team noted that among patients who underwent Roux-en-Y with gastric bypass, endoscopic success was 80% and ERCP success was 70%.
In patients who had undergone a Roux-en-Y with either a pancreaticoduodenectomy, pylorus-preserving pancreaticoduodenectomy, or hepaticojejunostomy, endoscopic success was 85% and ERCP success was 76%.
In patients who had undergone a Billroth II procedure, endoscopic success was 96% and ERCP success was 90%.
The research team noted that in patients with native papilla who underwent successful endoscopy, cannulation was successful in 90% of patients compared with 92% in patients with an anastomosis.
Overall ERCP success for all attempts was approximately 74%.
Interventions included sphincterotomy, pre-cut papillotomy, anastomotic stricturoplasty, stone removal, stent insertion, stent replacement, and balloon dilation of stenotic anastomosis.
The researchers found 32 major complications among the 945 procedures.
Dr Skinner's team concludes, "Both endoscopic and ERCP success rates were highest in patients with Billroth II anatomy, followed by those with pancreaticoduodenectomy and Roux-en-Y hepaticojejunostomy."
"The lowest success rates were in patients with Roux-en-Y gastric bypass."
"Cannulation rates appeared to be equivalent in patients with both native papilla and biliary-enteric or pancreaticoenteric anastomoses."
"The diagnostic and therapeutic potential of balloon-assisted ERCP were high and the adverse event rate was low."