Background and study aim: Overtube-assisted enteroscopy (OAE) techniques have increased the ability to perform
endoscopic retrograde cholangiopancreatography (ERCP) in patients with altered upper
gastrointestinal anatomy, such as Roux-en-Y gastric bypass. The aim of this study
was to compare the efficacy and safety of OAE-ERCP in patients with different configurations
of upper gastrointestinal anatomy.
Patients and methods: A systematic review was performed following a literature search for papers published
between 1966 and August 2013. The following databases were searched: MEDLINE (via
PubMed), Embase, Cochrane library, and Scopus. The following end points were analyzed:
diagnostic and therapeutic success rates, cannulation success rate, ERCP success rate,
type of enteroscopy, types of intervention, complications.
Results: A total of 23 relevant reports on OAE procedures, including single-balloon, double-balloon,
and spiral enteroscopy, were analyzed. Studies included a total of 945 procedures
in 679 patients (age 2 – 91 years) who had a variety of postsurgical upper gastrointestinal
anatomical configurations. Among patients who underwent Roux-en-Y with gastric bypass,
endoscopic success was 80 % and ERCP success was 70 %. In patients who had undergone
a Roux-en-Y with either a pancreaticoduodenectomy, pylorus-preserving pancreaticoduodenectomy,
or hepaticojejunostomy, endoscopic success was 85 % and ERCP success was 76 %. In
patients who had undergone a Billroth II procedure, endoscopic success was 96 % and
ERCP success was 90 %. In patients with native papilla who underwent successful endoscopy,
cannulation was successful in 90 % of patients compared with 92 % in patients with
an anastomosis. Overall ERCP success for all attempts was approximately 74 %. Interventions
included sphincterotomy, pre-cut papillotomy, anastomotic stricturoplasty, stone removal,
stent insertion, stent replacement, and balloon dilation of stenotic anastomosis.
There were 32 major complications among the 945 procedures (3.4 %).
Conclusion: Both endoscopic and ERCP success rates were highest in patients with Billroth II
anatomy, followed by those with pancreaticoduodenectomy and Roux-en-Y hepaticojejunostomy;
the lowest success rates were in patients with Roux-en-Y gastric bypass. Cannulation
rates appeared to be equivalent in patients with both native papilla and biliary-enteric
or pancreaticoenteric anastomoses. The diagnostic and therapeutic potential of balloon-assisted
ERCP were high and the adverse event rate was low.
