Status of single‐balloon enteroscopy‐assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: Systematic review and meta‐analysis on biliary interventions

Background and Aims Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is still challenging. Usefulness of single‐balloon enteroscopy (SBE)‐assisted ERCP has been increasingly reported. Short SBE is considered beneficial with a 152‐cm working length and a 3.2‐mm working channel. This has increased the variety of devices that can be used during ERCP procedures. The aim of this pooled analysis was to evaluate the efficacy of SBE‐assisted ERCP in patients with surgically altered anatomy and elucidate the current status. Methods This systematic review only involved biliary interventions which excluded pancreatic cases. Studies involving SBE‐assisted ERCP in patients with Roux‐en‐Y gastrectomy, hepaticojejunostomy with Roux‐en‐Y, pancreaticoduodenectomy (Whipple or Child procedure), or Billroth II gastrectomy were analyzed. Enteroscopy, biliary cannulation, and procedural success were assessed by pooling data in a random‐effect model, according to the degree of heterogeneity, to obtain a proportion with 95% confidence interval (CI). The outcomes observed for conventional and short SBE cases were also reported. Results Overall, 1227 SBE‐assisted ERCP procedures from 21 studies were included. The pooled enteroscopy, biliary cannulation, and procedural success rates were 86.6% (95% CI, 82.4–90.3%), 90% (95% CI, 87.1–92.5%), and 75.8% (95% CI, 71.0–80.3%), respectively. Adverse events occurred in 6.6% (95% CI, 5.3–8.2%) of the procedures. Although good outcomes were reported for short SBE‐assisted ERCP, these should not be directly compared to the outcomes observed for conventional SBE, as they assume different backgrounds and include confounding variables. Conclusions Single‐balloon enteroscopy‐assisted ERCP in patients with surgically altered anatomy on biliary interventions is effective.