Department of Medicine, Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York, USA.
Department of Preventive Medicine and Nutrition, Columbia University Medical Center, New York, New York, USA.
Gastrointest Endosc. 2015 Jul;82(1):9-19. doi: 10.1016/j.gie.2015.02.013. Epub 2015 Apr 25.
Surgically altered pancreaticobiliary anatomy increases the difficulty of performing ERCP. Single-balloon enteroscopy (SBE) is a relatively new technique that can be used for ERCP in patients with surgically altered anatomy.
To evaluate the therapeutic and diagnostic success of SBE-ERCP among patients with surgically altered anatomy.
DESIGN/SETTING: Systematic review and meta-analysis of studies involving SBE-ERCP in patients with Roux-en-Y gastric bypass, hepaticojejunostomy, or Whipple procedure. Enteroscopy success was defined as success in reaching the papilla and/or biliary anastomosis by using SBE. Diagnostic success was defined as obtaining a cholangiogram. Procedural success was defined as the ability to provide successful intervention, if appropriate. A random-effects model was used.
A total of 461 patients underwent SBE-ERCP from 15 trials. The pooled enteroscopy, diagnostic, and procedural success rates were 80.9% (95% confidence interval [CI], 75.3%-86.4%), 69.4% (95% CI, 61.0%-77.9%), and 61.7% (95% CI, 52.9%-70.5%), respectively. There was statistical large heterogeneity for enteroscopy, diagnostic, and therapeutic success (P < .001 for all). Adverse events occurred in 6.5% (95% CI, 4.7%-9.1%) of patients. There was no evidence of publication bias in this meta-analysis.
Our findings and interpretations are limited by the quantity and heterogeneity of the studies included in the analysis.
SBE-ERCP has high diagnostic and procedural success rates in this challenging patient population. It should be considered a first-line intervention when biliary access is required after Roux-en-Y gastric bypass, hepaticojejunostomy, or Whipple procedure.
手术改变的胰胆管解剖结构增加了 ERCP 的难度。单球囊小肠镜（SBE）是一种相对较新的技术，可用于手术改变解剖结构的患者进行 ERCP。
评估 SBE-ERCP 在 Roux-en-Y 胃旁路、肝肠吻合术或 Whipple 手术患者中的治疗和诊断成功率。
设计/设置：对涉及 Roux-en-Y 胃旁路、肝肠吻合术或 Whipple 手术患者的 SBE-ERCP 研究进行系统评价和荟萃分析。SBE 成功到达乳头和/或胆管吻合口定义为进入成功。诊断成功定义为获得胆管造影。如果合适，程序成功定义为能够提供成功的干预。使用随机效应模型。
共有 461 例患者接受了来自 15 项试验的 SBE-ERCP。汇总的 SBE 进入、诊断和程序成功率分别为 80.9%（95%可信区间[CI]，75.3%-86.4%）、69.4%（95% CI，61.0%-77.9%）和 61.7%（95% CI，52.9%-70.5%）。SBE 进入、诊断和治疗成功率存在统计学上的显著异质性（均 P<.001）。6.5%（95% CI，4.7%-9.1%）的患者发生不良事件。本荟萃分析未发现发表偏倚。
我们的发现和解释受到分析中纳入研究的数量和异质性的限制。
SBE-ERCP 在这一具有挑战性的患者群体中具有较高的诊断和程序成功率。在 Roux-en-Y 胃旁路、肝肠吻合术或 Whipple 手术后需要胆道进入时，应将其视为一线干预措施。
