Efficacy and factors affecting procedure results of short-type single-balloon enteroscopy–assisted ERCP for altered anatomy: a multicenter cohort in Japan

Tanisaka, Yuki; Ryozawa, Shomei; Itoi, Takao; Yamauchi, Hiroshi; Katanuma, Akio; Okabe, Yoshinobu; Irisawa, Atsushi; Nakahara, Kazunari; Iwasaki, Eisuke; Ishii, Kentaro; Kin, Toshifumi; Terabe, Hiroya; Izawa, Naoya; Morita, Ryo; Minami, Kazuhiro; Araki, Ryuichiro; Fujita, Akashi; Ogawa, Tomoya; Mizuide, Masafumi; Kida, Mitsuhiro

doi:10.1016/j.gie.2021.09.008

Cited by 35 publications

(52 citation statements)

References 25 publications

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“…The initial literature search resulted in 4105 studies, with 76 of them [ 11 , 13 , 15 , 17 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 ,…”

Section: Resultsunclassified

“…Sixteen studies [ 15 , 17 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 ] provided comparisons between two or more modalities. Fifty-five studies evaluated -EA-ERCP, including 53 with BA-ERCP [ 11 , 13 , 15 , 17 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ,…”

Section: Resultsmentioning

confidence: 99%

“…The pooled rate of technical success for EA-ERCP (55 studies, 2549 procedures) [ 11 , 13 , 15 , 17 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 92 , 93 , 95 , 96 , 97 , 98 , 101 , 102 , 103 ] was 87.3% [95%CI: 85.3–89.4] ( Figure 2 a). When focusing on the individual performance of different EA-ERCP modalities ( Supplementary Figure S1 ), SE-ERCP (4 s...…”

Section: Resultsmentioning

confidence: 99%

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Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

Gkolfakis

Papaefthymiou

Facciorusso

et al. 2022

Life

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Background and Aims: Endoscopic retrograde cholangiopancreatography (ERCP), in surgically altered anatomy (SAA), can be challenging and the optimal technique selection remains debatable. Most common foregut interventions resulting to this burden consist of Billroth II gastrectomy, Whipple surgery and Roux-en-Y anastomoses, including gastric by-pass. This systematic review, with meta-analysis, aimed to compare the rates of successful enteroscope-assisted (EA)-, endosonography-directed transgastric- (EDGE), and laparoscopy-assisted (LA)-ERCP. Methods: A systematic research (Medline) was performed for relative studies, through January 2022. The primary outcome was technical success, defined as approaching the ampulla site. Secondary outcomes included the desired duct cannulation, successful therapeutic manipulations, and complication rates. We performed meta-analyses of pooled data, and subgroup analysis considering the EA-ERCP subtypes (spiral-, double and single balloon-enteroscope). Pooled rates are reported as percentages with 95% Confidence Intervals (95%CIs). Results: Seventy-six studies were included (3569 procedures). Regarding primary outcome, EA-ERCP was the least effective [87.3% (95%CI: 85.3–89.4); I2: 91.0%], whereas EDGE and LA-ERCP succeeded in 97.9% (95%CI: 96.4–99.4; I2: 0%) and 99.1% (95%CI: 98.6–99.7; I2: 0%), respectively. Similarly, duct cannulation and therapeutic success rates were 74.7% (95%CI: 71.3–78.0; I2: 86.9%) and 69.1% (95%CI: 65.3–72.9; I2: 91.8%) after EA-ERCP, 98% (95%CI: 96.5–99.6; I2: 0%) and 97.9% (95%CI: 96.3–99.4) after EDGE, and 98.6% (95%CI: 97.9–99.2; I2: 0%) and 98.5% (95%CI: 97.8–99.2; I2: 0%) after LA-ERCP, respectively. The noticed high heterogeneity in EA-ERCP results probably reflects the larger number of included studies, the different enteroscopy modalities and the variety of surgical interventions. Comparisons revealed the superiority of LA-ERCP and EDGE over EA-ERCP (p ≤ 0.001) for all success-related outcomes, though LA-ERCP and EDGE were comparable (p ≥ 0.43). ERCP with spiral-enteroscope was inferior to balloon-enteroscope, while the type of the balloon-enteroscope did not affect the results. Most adverse events were recorded after LA-ERCP [15.1% (95%CI: 9.40–20.8); I2: 87.1%], and EDGE [13.1% (95%CI: 7.50–18.8); I2: 48.2%], significantly differing from EA-ERCP [5.7% (95%CI: 4.50–6.80); p ≤ 0.04; I2: 64.2%]. Conclusions: LA-ERCP and EDGE were associated with higher technical, cannulation, and therapeutic success compared to EA-ERCP, though accompanied with more adverse events.

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Section: Resultsunclassified

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

Gkolfakis

Papaefthymiou

Facciorusso

et al. 2022

Life

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“…Adverse events occurred in 7.7% of patients. 19 A systematic review and meta-analysis that was mentioned previously reported that the pooled enteroscopy, cannulation, and procedural success rates were 86.6%, 90%, and 75.8%, respectively. Adverse events occurred in 6.6% of the pro-cedures.…”

Section: Single-balloon Enteroscopy-assisted Ercpmentioning

confidence: 96%

“…10 Similarly, a multicenter study reported that the factors that affected procedural failure were malignancy, pancreatic indication, and Rouxen-Y reconstruction. 19…”

Section: Single-balloon Enteroscopy-assisted Ercpmentioning

confidence: 99%

Balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

Tanisaka

Mizuide

Fujita

et al. 2022

Int J Gastrointest Interv

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Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosis and intervention in patients with biliopancreatic disorders. However, ERCP in patients with surgically altered anatomy (SAA) is considered more difficult than in patients with normal anatomy. Since the introduction of balloon enteroscopes for patients with small intestine disorders, single-balloon enteroscopes (SBEs) and double-balloon enteroscopes (DBEs) have also been used for biliopancreatic diseases in patients with SAA. Nevertheless, the use of conventional SBEs and DBEs is limited, as a balloon enteroscope has a working length of 200 cm and a narrow working channel with a diameter of 2.8 mm; therefore, few ERCP accessories are available for use. A short-type SBE with a working length of 152 cm and a working channel of 3.2 mm in diameter, and a short-type DBE with a working length of 155 cm and a working channel of 3.2 mm were introduced to solve these difficulties. Favorable outcomes of these devices have recently been reported. Moreover, studies have reported several tips to achieve procedural success and factors affecting procedure failure. Difficult cases necessitate alternative techniques, such as percutaneous transhepatic biliary drainage and endoscopic ultrasound-guided biliary drainage.

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Competence development of trainees performing short‐type single‐balloon enteroscopy‐assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

Tanisaka

Mizuide

Fujita

et al. 2022

J Hepato Biliary Pancreat

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Objectives: This study aimed to evaluate the trainees' practice and learning curve in short-type single-balloon enteroscopy (short SBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy (SAA) and determine how to train these trainees. Methods:The data of short SBE-assisted ERCP procedures between September 2011 and June 2021 were analyzed.Results: Three trainees and 180 cases were included in the analysis. Each trainee performed 60 cases between April 2016 and June 2021. The trainees' completion rate was 73.9% (95% confidence interval [CI], 66.8-80.1%). Adverse events occurred in 5.0% of cases (95% CI, 2.3-9.3%). The trainee who experienced colonoscopy and ERCP the most achieved better outcomes of enteroscopy success (reaching the target site) and trainee's completion rates than those of the others (P = .03 and .02, respectively). The learning curve for trainee's completion showed a significant improvement after 60 cases (P = .001). Multiple logistic regression analysis indicated that Roux-en-Y reconstruction was the factor affecting trainees' completion failure.Conclusions: Short SBE-assisted ERCP trainees has a substantial learning curve.If trainees do not have much experience with colonoscopy and ERCP procedures, it may be beneficial for them to start performing short SBE-assisted ERCP procedures on non-Roux-en-Y reconstruction cases.

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Efficacy and factors affecting procedure results of short-type single-balloon enteroscopy–assisted ERCP for altered anatomy: a multicenter cohort in Japan

Cited by 35 publications

References 25 publications

Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

Balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

Competence development of trainees performing short‐type single‐balloon enteroscopy‐assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

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