Efficacy and safety of double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in surgically altered anatomy: A systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered gastrointestinal anatomy poses significant challenges. Double-balloon enteroscopy-assisted ERCP (DBE-ERCP) has emerged as a safe and effective approach in this patient population. This study aims to provide an updated systematic review and meta-analysis of the safety and efficacy of DBE-ERCP in patients with surgically altered anatomy (SAA), building on previously published evidence. AIM To evaluate the safety and efficacy of DBE-ERCP in patients with SAA through an updated systematic review and meta-analysis and to compare outcomes between short- and long-scope double-balloon enteroscopy (DBE). METHODS A comprehensive search of PubMed, EMBASE, and Web of Science was performed for studies published up to March 2025 investigating DBE-ERCP in patients with surgically altered gastrointestinal anatomy. A random-effects model was applied to conduct a meta-analysis of proportions. The risk of bias was evaluated using the Newcastle-Ottawa Scale and the Joanna Briggs Institute Scale. Heterogeneity was evaluated using the inconsistency statistic (I 2). Publication bias was examined using funnel plots and Egger’s regression test. RESULTS A total of 40 studies were included, comprising 10 cohort studies and 30 case series, including 2689 patients who underwent 3478 procedures. The surgical procedures were primarily classified into three categories: Roux-en-Y reconstruction (including hepaticojejunostomy, gastric bypass, and choledochojejunostomy, etc. ) in 1156 cases; pancreaticoduodenectomy (performed using either the Whipple or Child technique) in 549 cases; and Billroth II anastomosis in 265 cases. The combined success rate for reaching the papilla was 92% (95%CI: 89%-95%). The overall enteroscopy success rate was 89% (95%CI: 85%-92%). The pooled diagnostic success rate was 90% (95%CI: 85%-95%), while the therapeutic success rate reached 92% (95%CI: 89%-95%). Adverse events reported in 5.7% of patients (95%CI: 4.1%-7.5%). Subgroup analysis comparing short-scope and long-scope demonstrated that the short DBE was superior in terms of papilla reached rate, enteroscopy success, and procedural success. No significant differences were observed between groups in diagnostic success or adverse events. CONCLUSION DBE-ERCP demonstrates both safety and efficacy in patients with SAA. Compared to long-scope DBE, short-scope DBE shows greater clinical promise; however, further randomized controlled trials are warranted to validate these findings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.035 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.042 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".