Ahmed Zohaib, Iqbal Amna, Aziz Muhammad, Iqbal Fatima, Gangwani Manesh Kumar, Sohail Abdullah, Chaudhary Ammad, Smith Wade-Lee, Hayat Umar, Singh Shailendra, Mohan Babu P, Javaid Toseef
Department of Gastroenterology and Hepatology, University of Toledo, Ohio, USA (Zohaib Ahmed).
Department of Internal Medicine, University of Toledo, Ohio, USA (Amna Iqbal, Manesh Kumar Gangwani).
Ann Gastroenterol. 2024 Jul-Aug;37(4):493-498. doi: 10.20524/aog.2024.0888. Epub 2024 Jun 14.
The safety and technical success of endoscopic ultrasound-guided antegrade treatment (EUS-AG) compared to balloon enteroscopy-assisted endoscopic cholangiopancreatography (BE-ERCP) for choledocholithiasis in Roux-en-Y gastrectomy has not been well documented. We performed a systematic review and meta-analysis to assess the safety and efficacy of the 2 procedures.
A systematic search of multiple databases was undertaken through January 25, 2024, to identify relevant studies comparing the 2 procedures. Standard meta-analysis methods were employed using a random-effects model. For each outcome, risk-ratio (RR), 95% confidence interval (CI), and P-values were generated. P<0.05 was considered significant. Heterogeneity was assessed using the statistic.
Three studies with 795 patients (95 in the EUS-AG group and 700 in the BE-ERCP group) were included. The technical success rate was similar between EUS-AG and BE-ERCP (RR 1.08, 95%CI 0.84-1.38; P=0.57; =56%). The overall rate of adverse effects was higher in the BE-ERCP group than in the EUS-AG group (RR 1.95, 95%CI 1.21-3.15; P=0.006; =0 %). Rates of clinical success, pancreatitis, perforation, and bile peritonitis were similar between the 2 procedure techniques.
Our analysis showed no distinct advantage in using one technique over the other for patients with Roux-en-Y anatomy in achieving technical and clinical success. However, the incidence of adverse effects was greater in the BE-ERCP group than in the EUS-AG group.
对于 Roux-en-Y 胃切除术后胆总管结石患者，与球囊小肠镜辅助内镜逆行胰胆管造影术（BE-ERCP）相比，内镜超声引导下顺行治疗（EUS-AG）的安全性和技术成功率尚未得到充分记录。我们进行了一项系统评价和荟萃分析，以评估这两种手术的安全性和有效性。
截至2024年1月25日，对多个数据库进行了系统检索，以确定比较这两种手术的相关研究。采用随机效应模型的标准荟萃分析方法。针对每个结局，生成风险比（RR）、95%置信区间（CI）和P值。P<0.05被认为具有统计学意义。使用I²统计量评估异质性。
纳入了3项研究，共795例患者（EUS-AG组95例，BE-ERCP组700例）。EUS-AG和BE-ERCP的技术成功率相似（RR 1.08，95%CI 0.84-1.38；P=0.57；I²=56%）。BE-ERCP组的总体不良反应发生率高于EUS-AG组（RR 1.95，95%CI 1.21-3.15；P=0.006；I²=0%）。两种手术技术的临床成功率、胰腺炎、穿孔和胆汁性腹膜炎发生率相似。
我们的分析表明，对于具有 Roux-en-Y 解剖结构的患者，在实现技术和临床成功方面，一种技术相对于另一种技术没有明显优势。然而，BE-ERCP组的不良反应发生率高于EUS-AG组。
