经手术改变解剖结构患者中单气囊小肠镜辅助下内镜逆行胰胆管造影术的应用现状：胆道介入治疗的系统评价和荟萃分析。

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

机构信息

Department of Gastroenterology, Saitama Medical University International Medical Center, Japan.

Community Health Science Center, Saitama Medical University, Saitama, Japan.

出版信息

Dig Endosc. 2021 Nov;33(7):1034-1044. doi: 10.1111/den.13878. Epub 2020 Nov 18.

DOI:10.1111/den.13878

PMID:33073407

Abstract

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.

摘要

背景与目的

经内镜逆行胰胆管造影术（ERCP）在解剖结构改变的患者中仍然具有挑战性。越来越多的报道表明，单气囊小肠镜（SBE）辅助 ERCP 的有效性。短 SBE 因其具有 152cm 的工作长度和 3.2mm 的工作通道而被认为具有优势。这增加了可在 ERCP 手术中使用的设备种类。本汇总分析的目的是评估 SBE 辅助 ERCP 在解剖结构改变的患者中的疗效，并阐明其现状。

方法

本系统评价仅涉及胆管介入，排除了胰腺病例。分析了 SBE 辅助 Roux-en-Y 胃切除术、Roux-en-Y 肝肠吻合术、胰十二指肠切除术（Whipple 或 Child 手术）或 Billroth II 胃切除术患者的 ERCP 研究。根据异质性程度，采用随机效应模型汇总数据评估小肠镜、胆管插管和手术成功率，以获得 95%置信区间（CI）的比例。还报告了常规和短 SBE 病例的观察结果。

结果

总体而言，纳入了 21 项研究的 1227 例 SBE 辅助 ERCP 手术。汇总的小肠镜、胆管插管和手术成功率分别为 86.6%（95%CI，82.4-90.3%）、90%（95%CI，87.1-92.5%）和 75.8%（95%CI，71.0-80.3%）。6.6%（95%CI，5.3-8.2%）的手术发生了不良事件。尽管短 SBE 辅助 ERCP 的结果良好，但这些结果不应直接与常规 SBE 的结果进行比较，因为它们假设了不同的背景并包含了混杂变量。