ERCP with overtube-assisted enteroscopy in patients with Roux-en-Y gastric bypass anatomy: a systematic review and meta-analysis.
Endoscopy
; 52(10): 824-832, 2020 10.
Article
em En
| MEDLINE
| ID: mdl-32492751
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass (RYGB) anatomy is challenging. Overtube-assisted enteroscopy (OAE) is usually needed to perform ERCP in these patients. There is significant variation in the reported rates of success and adverse events across published studies. We performed a systematic review and meta-analysis to reliably estimate the pooled rates of success and adverse events. METHODS: We performed a systematic search of multiple electronic databases through February 2020 to identify studies reporting outcomes of OAE-ERCP in post-RYGB patients. The pooled rates of enteroscopy success, technical success, and adverse events were estimated for OAE-ERCP. The pooled rates of success and adverse events were also estimated for ERCP using double-balloon enteroscopes (DBE) alone. RESULTS: 10 studies reporting a total of 398 procedures were included in the meta-analysis. The pooled rates of enteroscopy and technical success of OAE-ERCP were 75.3â% (95â% confidence interval [CI] 64.5â-â83.6) and 64.8â% (95â%CI 53.1â-â74.9) respectively. The pooled rate of adverse events was 8.0â% (95â%CI 5.2â-â12.2). The pooled rates of enteroscopy and technical success of DBE-ERCP (four studies) were 83.5â% (95â%CI 68.3â-â92.2) and 72.5â% (95â%CI 52.3â-â86.4), respectively. The pooled rate of adverse events with DBE-ERCP was 9.0â% (95â%CI 5.4â-â14.5). Substantial heterogeneity was noted. CONCLUSIONS: OAE-ERCP appears to be effective and safe in post-RYGB patients. Among the currently available techniques, OAE-ERCP is the least invasive approach in this challenging group of patients. Future studies comparing the effectiveness and safety of alternative novel techniques, such as endosonography-directed transgastric ERCP, with OAE-ERCP are needed.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Derivação Gástrica
/
Laparoscopia
Tipo de estudo:
Observational_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
Endoscopy
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Estados Unidos