Department of Internal Medicine, Inje University Seoul Paik Hospital, Seoul 04551, South Korea.
Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea.
World J Gastroenterol. 2019 Jun 28;25(24):3091-3107. doi: 10.3748/wjg.v25.i24.3091.
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy has been considered a challenging procedure due to the surgically altered gastrointestinal anatomy. However, there has been a paucity of comparative studies regarding ERCP in Billroth II gastrectomy cases because of procedure-related morbidity and mortality and practical and ethical limitations. This systematic and comprehensive review was performed to obtain a recent perspective on ERCP in Billroth II gastrectomy patients.
To systematically review the literature regarding ERCP in Billroth II gastrectomy patients.
A systematic review was performed on the literature published between May 1975 and January 2019. The following electronic databases were searched: PubMed, EMBASE, and Cochrane Library. The outcomes of successful afferent loop intubation and successful selective cannulation and occurrence of adverse events were assessed.
A total of 43 studies involving 2669 patients were included. The study designs were 36 (83.7%) retrospective cohort studies, 4 (9.3%) retrospective comparative studies, 2 (4.7%) prospective comparative studies, and 1 (2.3%) prospective cohort study. Of a total of 2669 patients, there were 1432 cases (55.6%) of side-viewing endoscopy, 664 (25.8%) cases of forward-viewing endoscopy, 171 (6.6%) cases of balloon-assisted enteroscopy, 169 (6.6%) cases of anterior oblique-viewing endoscopy, 64 (2.5%) cases of dual-lumen endoscopy, 31 (1.2%) cases of colonoscopy, and 14 (0.5%) cases of multiple bending endoscopy. The overall success rate of afferent loop intubation was 91.3% (2437/2669), and the overall success rate of selective cannulation was 87.9% (2346/2437). A total of 195 cases (7.3%) of adverse events occurred. The success rates of afferent loop intubation and the selective cannulation rate for each type of endoscopy were as follows: side-viewing endoscopy 98.2% and 95.3%; forward-viewing endoscopy 97.4% and 95.2%; balloon-assisted enteroscopy 95.4% and 97.5%; oblique-viewing endoscopy 94.1% and 97.5%; and dual-lumen endoscopy 82.8% and 100%, respectively. The rate of bowel perforation was slightly higher in side-viewing endoscopy (3.6%) and balloon-assisted enteroscopy (4.1%) compared with forward-viewing endoscopy (1.7%) and anterior oblique-viewing endoscopy (1.2%). Mortality only occurred in side-viewing endoscopy ( = 9, 0.6%).
The performance of ERCP in the Billroth II gastrectomy population has been improving with choice of various type of endoscope and sphincter management. More comparative studies are needed to determine the optimal strategy to perform safe and effective ERCP in Billroth II gastrectomy patients.
由于胃肠道解剖结构发生了变化，经内镜逆行胰胆管造影术（ERCP）在毕罗氏Ⅱ式胃切除术后患者中被认为是一项具有挑战性的操作。然而，由于与手术相关的发病率和死亡率以及实际和伦理方面的限制，关于毕罗氏Ⅱ式胃切除术后 ERCP 的比较研究很少。本系统全面的综述旨在获得毕罗氏Ⅱ式胃切除术后患者 ERCP 的最新观点。
系统地回顾毕罗氏Ⅱ式胃切除术后 ERCP 的文献。
对 1975 年 5 月至 2019 年 1 月期间发表的文献进行系统综述。检索了以下电子数据库：PubMed、EMBASE 和 Cochrane 图书馆。评估了成功插管和选择性插管的成功率以及不良事件的发生情况。
共纳入 43 项研究，涉及 2669 例患者。研究设计为 36 项（83.7%）回顾性队列研究、4 项（9.3%）回顾性对照研究、2 项（4.7%）前瞻性对照研究和 1 项（2.3%）前瞻性队列研究。在总共 2669 例患者中，侧视内镜 1432 例（55.6%），前视内镜 664 例（25.8%），球囊辅助进镜 171 例（6.6%），前斜视内镜 169 例（6.6%），双腔内镜 64 例（2.5%），结肠镜 31 例（1.2%），多弯曲内镜 14 例（0.5%）。总的插管成功率为 91.3%（2437/2669），选择性插管成功率为 87.9%（2346/2437）。共有 195 例（7.3%）发生不良事件。每种内镜的插管成功率和选择性插管率如下：侧视内镜 98.2%和 95.3%；前视内镜 97.4%和 95.2%；球囊辅助进镜 95.4%和 97.5%；前斜视内镜 94.1%和 97.5%；双腔内镜 82.8%和 100%。与前视内镜（1.7%）和前斜视内镜（1.2%）相比，侧视内镜（3.6%）和球囊辅助进镜（4.1%）的肠穿孔发生率略高。死亡率仅发生在侧视内镜（ = 9，0.6%）。
随着各种内镜类型和括约肌管理方法的选择，毕罗氏Ⅱ式胃切除术后 ERCP 的操作性能得到了改善。需要更多的比较研究来确定在毕罗氏Ⅱ式胃切除术后患者中进行安全有效的 ERCP 的最佳策略。
