de Oliveira Victor L, de Moura Diogo Turiani H, do Monte Júnior Epifânio S, Proença Igor M, Ribeiro Igor B, Sánchez-Luna Sergio A, Ribas Pedro Henrique Boraschi V, Hemerly Matheus C, Bernardo Wanderley M, de Moura Eduardo Guimarães H
Gastroenterology, Hospital das Clínicas da Universidade de São Paulo, Sao Paulo, BRA.
Gastroenterology, University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, USA.
Cureus. 2022 Oct 11;14(10):e30196. doi: 10.7759/cureus.30196. eCollection 2022 Oct.
Endoscopic retrograde cholangiopancreatography (ERCP) is a therapeutic procedure for skilled endoscopists that can be even more challenging in some situations, including patients' post-Roux-en-y Gastric Bypass (RYGB) surgery. There is still no consensus on whether laparoscopic-assisted ERCP (LA-ERCP) or endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) is the most appropriate, safe, and feasible approach in patients with this type of post-surgical anatomy. This systematic review and meta-analysis aimed to examine both approaches' feasibility, efficacy, and safety in this situation. We searched for electronic databases (MEDLINE, EMBASE, Lilacs, Google Scholar, and Central Cochrane) to identify studies comparing LA-ERCP versus EDGE. Outcomes measured included technical success, adverse events (AEs) and serious AEs, length of stay (LOS), and procedural time. Descriptive data related to the EDGE procedure was also extracted. The risk of bias and the quality of evidence of the enrolled studies were assessed. Five studies, totalizing 268 patients (176 LA-ERCP and 92 EDGE), were included. There was no statistical difference in technical success and AEs between groups; however, the LOS and procedural times were shorter for the EDGE group. High rates of fistula closure and no weight regain were observed in EDGE. Both methods are feasible and safe techniques to perform ERCP in patients with RYGB anatomy, with comparable technical success and adverse events rate. However, EDGE is associated with shorter LOS and procedural time.
内镜逆行胰胆管造影术（ERCP）是一项针对技术娴熟的内镜医师的治疗性操作，在某些情况下可能更具挑战性，包括接受过Roux-en-Y胃旁路术（RYGB）的患者。对于腹腔镜辅助ERCP（LA-ERCP）或内镜超声（EUS）引导下经胃ERCP（EDGE）是否是这类术后解剖结构患者最合适、最安全且最可行的方法，目前仍未达成共识。本系统评价和荟萃分析旨在研究这两种方法在此种情况下的可行性、有效性和安全性。我们检索了电子数据库（MEDLINE、EMBASE、Lilacs、谷歌学术和Cochrane中心对照试验注册库），以识别比较LA-ERCP与EDGE的研究。测量的结果包括技术成功率、不良事件（AE）和严重不良事件、住院时间（LOS）和操作时间。还提取了与EDGE操作相关的描述性数据。评估了纳入研究的偏倚风险和证据质量。纳入了5项研究，共计268例患者（176例行LA-ERCP，92例行EDGE）。两组之间在技术成功率和不良事件方面无统计学差异；然而，EDGE组的住院时间和操作时间更短。在EDGE组中观察到较高的瘘管闭合率且体重未增加。两种方法都是对具有RYGB术后解剖结构的患者进行ERCP的可行且安全的技术，技术成功率和不良事件发生率相当。然而，EDGE与更短的住院时间和操作时间相关。
