ERCP with the overtube-assisted enteroscopy technique: a systematic review.

Area of Science:

• Gastroenterology
• Endoscopy
• Surgical Anatomy

Background:

• Altered upper gastrointestinal anatomy, particularly after bariatric surgery like Roux-en-Y gastric bypass, presents challenges for endoscopic retrograde cholangiopancreatography (ERCP).
• Overtube-assisted enteroscopy (OAE) techniques have emerged to improve access and success rates for ERCP in these complex cases.

Purpose of the Study:

• To compare the efficacy and safety of OAE-ERCP in patients with diverse postsurgical upper gastrointestinal anatomical configurations.
• To evaluate diagnostic and therapeutic success rates, cannulation success, and complication rates associated with OAE-ERCP.

Main Methods:

• A systematic review of literature published between 1966 and August 2013 was conducted.
• Databases searched included MEDLINE, Embase, Cochrane library, and Scopus.
• Analysis focused on diagnostic/therapeutic success, cannulation, ERCP success, enteroscopy type, interventions, and complications.

Main Results:

• Analysis of 945 OAE procedures in 679 patients revealed varying success rates based on anatomy.
• Endoscopic and ERCP success rates were highest in Billroth II (96% and 90%) and lowest in Roux-en-Y gastric bypass (80% and 70%).
• Overall ERCP success was ~74%, with a major complication rate of 3.4%.

Conclusions:

• OAE-ERCP demonstrates high diagnostic and therapeutic potential with a low adverse event rate.
• Success rates for OAE-ERCP are highest in Billroth II anatomy, followed by pancreaticoduodenectomy/hepaticojejunostomy, and Roux-en-Y gastric bypass.
• Cannulation rates were comparable between native papilla and anastomotic sites.