Double-balloon enteroscopy for diagnostic and therapeutic ERCP in patients with surgically altered gastrointestinal anatomy: a systematic review and meta-analysis

Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered gastrointestinal anatomy is challenging. Double-balloon enteroscopy (DBE) has been shown to be safe and efficacious for ERCP in these patients but attempts to synthesize existing data are limited. The purpose of this study was to conduct a systematic review and meta-analysis to evaluate the safety and efficacy of DBE-ERCP in surgically altered anatomy. We searched MEDLINE, EMBASE, and CENTRAL databases through March 2020 for studies that conducted DBE-ERCP in patients with surgically altered gastrointestinal anatomy. Primary outcomes were enteroscopic, diagnostic, and procedural success rates of DBE-ERCP. Secondary outcomes were adverse events after DBE-ERCP. Random effects meta-analysis of proportions was performed when appropriate. The Newcastle–Ottawa scale was used to evaluate risk of bias. Heterogeneity was assessed using the inconsistency (I2) statistic. 24 studies involving 1523 patients were included. The pooled enteroscopic, diagnostic, and procedural success rates of DBE-ERCP were 90% (95% confidence interval (CI), 84–94%), 94% (95% CI 88–98%), and 93% (95% CI 88–97%). Adverse events were reported in 4% (95% CI 3–6%) of cases. Subgroup analysis of short-scope DBE-ERCP (