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Forward-viewing endoscope for ERCP in patients with Billroth II gastrectomy: a systematic review and meta-analysis

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Abstract

Background

The forward-viewing endoscope has been increasingly used to perform endoscopic retrograde cholangiopancreatography (ERCP) in patients who underwent Billroth II gastrectomy. This study intended to assess efficacy and safety of the forward-viewing endoscope for ERCP in Billroth II gastrectomy patients compared with conventional side-viewing endoscope using a systematic review and meta-analysis.

Methods

A systematic review was conducted for studies that evaluated the outcomes of ERCP for patients with Billroth II gastrectomy. Random-effect model meta-analyses with subgroup analyses were conducted. The methodological quality of the included publications was evaluated using the risk of bias assessment tool for non-randomized studies. The publication bias was assessed.

Results

In total, 25 studies (1 randomized, 18 retrospective, 1 prospective, and 5 case series studies) with 2446 patients (499 forward-viewing and 1947 side-viewing endoscopes) were analyzed. The pooled afferent loop intubation rate was higher with the forward-viewing endoscope (90.3%, 95% confidence interval (CI) 85.6–93.6 vs. 86.8%, 95% CI 82.8–89.9%). The pooled selective cannulation rate was higher with the side-viewing endoscope (92.3%, 95% CI 88.0–95.2 vs. 91.1%, 95% CI 87.2–93.9%). The pooled bowel perforation rate was higher with the side-viewing endoscope (3.6%, 95% CI 2.3–5.7 vs. 3.0%, 95% CI 1.7–5.3%). The pooled pancreatitis rate was higher with the forward-viewing endoscope (5.4%, 95% CI 3.6–8.0 vs. 2.5%, 95% CI 2.3–5.7%). The pooled bleeding rate was higher with the forward-viewing endoscope (3.0%, 95% CI 1.6–5.5 vs. 2.0%, 95% CI 1.4–3.0%). The heterogeneity among the studies was not significant. The publication bias was minimal.

Conclusion

This meta-analysis indicates that the forward-viewing endoscope is as safe and effective as conventional side-viewing endoscope for ERCP in patients with Billroth II gastrectomy.

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Abbreviations

ERCP:

Endoscopic retrograde cholangiopancreatography

RoBANS:

Risk of bias assessment tool for non-randomized studies

ROB:

Risk of bias

CIs:

Confidence intervals

EPBD:

Endoscopic papillary balloon dilation

EST:

Endoscopic sphincterotomy

EPLBD:

Endoscopic papillary large balloon dilation

MRCP:

Magnetic resonance cholangiopancreatography

A-loop:

Afferent loop

NK:

Needle knife

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Author notes

  1. Tae Young Park and Chang Seok Bang have contributed equally to this study as first author.

Authors and Affiliations

  1. Department of Internal Medicine, Inje University Seoul Paik Hospital, 9 Mareunnae-ro, Jung-gu, Seoul, South Korea

    Tae Young Park

  2. Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea

    Chang Seok Bang, Sang Hyeon Choi, Young Joo Yang, Suk Pyo Shin, Ki Tae Suk, Gwang Ho Baik & Dong Joon Kim

  3. Department of Internal Medicine, Gwangmyeong Sungae Hospital, Gwangmyeong, South Korea

    Jai Hoon Yoon

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Contributions

Study concept and design: TYP; acquisition of data: TYP, CSB, SHC, YJY, SPS; analysis of data: CSB; interpreting data: TYP, CSB, JHY, KTS, GHB, JHY; drafting manuscript: TYP, CSB; critical revision of manuscript: DJK.

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Correspondence to Tae Young Park.

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Drs. Tae Young Park, Chang Seok Bang, Sang Hyeon Choi, Young Joo Yang, Suk Pyo Shin, Ki Tae Suk, Gwang Ho Baik, Dong Joon Kim, and Jai Hoon Yoon have no conflicts of interest or financial ties to disclose.

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Park, T.Y., Bang, C.S., Choi, S.H. et al. Forward-viewing endoscope for ERCP in patients with Billroth II gastrectomy: a systematic review and meta-analysis. Surg Endosc 32, 4598–4613 (2018). https://doi.org/10.1007/s00464-018-6213-1

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