Efficacy and safety of double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in surgically altered anatomy: A systematic review and meta-analysis

Table 5 Double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography outcomes

Ref.	Anastomosis/papilla reached, % (n/N)	Enteroscopy success, % (n/N)	Diagnostic success, % (n/N)	Procedural success, % (n/N)	Adverse events, % (n/N)	Adverse event description
Aabakken et al[34]	94 (17/18)	83.3 (15/18)	100 (15/15)	100 (9/9)	0 (0/16)	-
Emmett and Mallat[35]	85 (17/20)	94.1 (16/17)	-	100 (10/10)	0 (0/20)	-
Maaser et al[36]	72.7 (8/11)	64 (7/11)	64 (7/11)	100 (5/5)	0 (0/11)	-
Mönkemüller et al[37]	90.9 (10/11)	90.9 (10/11)	81.81 (9/11)	60 (6/10)	9.09 (1/11)	Perforation of hepatocolejunostomy during balloon dilatation (n = 1)
Moreels et al[38]	86.7 (13/15)	80 (12/15)	80 (12/15)	80 (12/15)	13.3 (2/15)	Perforation (n = 2)
Pohl et al[39]	84 (22/25)	84 (22/25)	-	100 (16/16)	0 (0/15)	-
Shimatani et al[25]	97 (100/103)	-	98 (98/100)	100 (98/98)	5 (5/103)	Retroperitoneal emphysema (n = 1), Intestinal perforation (n = 1), Retroperitoneal perforation (n = 1), Post-endoscopic sphincterotomy perforation (n = 1), Subcutaneous emphysema with pneumothorax (n = 1)
Parlak et al[40]	92.86 (13/14)	92.86 (13/14)	92.86 (13/14)	85.71 (12/14)	7.14 (1/14)	Perforation (n = 1)
Cho et al[41]	86.2 (25/29)	82.76 (24/29)	83 (16/20)	100 (24/24)	0 (0/20)	-
Mönkemüller et al[42]	-	77.8 (14/18)	92.9 (13/14)	69.2 (9/13)	5.6 (1/18)	Perforation (n = 1)
Raithel et al[43]	74.2 (23/31)	-	-	87.2 (75/86)	5.8 (5/86)	Post-ERCP pancreatitis (n = 2), Post-interventional bleeding (n = 1), Perforation (n = 2)
Chua and Kaffes[44]	-	77.8 (14/18)	77.8 (14/18)	80 (8/10)	-	-
Osoegawa et al[45]	95.7 (45/47)	88.9 (40/45)	88.9 (40/45)	100 (40/40)	2.1 (1/47)	Perforation (n = 1)
Siddiqui et al[46]	89.9 (71/79)	90.1 (64/71)	90.1 (64/71)	100 (64/64)	5.1 (4/79)	Mild post-ERCP pancreatitis (n = 3), Self-limited bleeding (n = 1)
Shah et al[8]	74 (20/27)	-	-	63 (17/27)	-	Pancreatitis (n = 5), Mild bleeding (n = 1), Abdominal pain requiring hospital admit (n = 3), Throat pain requiring physician contact (n = 4), Perforation (n = 2), Death (n = 1), Reported for all interventions including SBE, DBE, and rotational ERCP
Varabei et al[47]	63.6 (21/33)	63.6 (21/33)	61.9 (20/33)	57.14 (12/21)	-	-
Cheng et al[26]	95 (73/77)	89.61 (69/77)	-	87 (67/77)	6.5 (5/77)	Minor perforation (n = 2), Mucosal tear (n = 2), Intestinal perforation (n = 1)
Sakakihara et al[48]	86.4 (38/44)	-	-	81.8 (36/44)	15.9 (7/44)	Cholangitis (n = 7)
Tsou et al[58]	83 (39/47)	94.9 (37/39)	94.9 (37/39)	100 (37/37)	4.3 (2/47)	Intestinal perforation (n = 1), Biliary tract infection (n = 1)
Tsutsumi et al[49]	98.61 (71/72)	98.61 (71/72)	98.61 (71/72)	100 (59/59)	2.72 (2/72)	Cholangitis (n = 2)
De Koning and Moreels[6]	-	-	-	73 (22/30)	10 (3/30)	Retroperitoneal free air (n = 3), Post-ERCP cholangitis (n = 2), Post-ERCP pancreatitis (n = 2), Liver capsule dehiscence (n = 1), (List includes complications for both DBE and SBE procedures in study)
Shimatani et al[50]	97.7 (304/311)	-	96.4 (293/304)	97.9 (277/283)	10.6 (33/311)	Obvious perforation (n = 1), Microperforation (n = 6), Mucosal laceration (n = 1), Biliary damage (n = 4), Pancreatitis (n = 11), Cholangitis (n = 8), Aspiration pneumonia (n = 2)
Tomoda et al[59]	85 (17/20)	85 (17/20)	70 (14/20)	55 (11/20)	10 (2/20)	Bleeding (n = 1), Ischemic liver graft (n = 1)
Liu et al[60]	76 (65/86)	70 (60/86)	100 (1/1)	89.4 (42/47)	2.33 (2/86)	Post-procedure cholangitis (n = 1), Aspiration pneumonia (n = 1)
Shimatani et al[7]	99.1 (111/112)	-	98.2 (109/111)	100 (109/109)	2.7 (3/112)	Laceration in intestinal tract (n = 3)
Tsutsumi et al[61]	97 (32/33; 30/33 short DBE, 2/33 Long DBE)	97 (32/33; 30/33 short DBE, 2/33 Long DBE)	81 (26/32; 21/32 short DBE, 5/32 Long DBE)	-	18.18 (6/33)	Perforation and pneumatosis (n = 3), Cholangitis (n = 1), Elevated hepatobiliary enzymes (n = 1), Mucosal laceration of ilium (n = 1)
Kashani et al[31]	93.8 (121/129)	94.57 (87/92)	-	94.57 (87/92)	10.1 (13/129)	Pancreatitis (n = 10), Cholangitis (n = 1), Perforation (n = 2)
Matsumoto et al[51]	100 (11/11)	100 (11/11)	-	63.6 (7/11)	0 (0/11)	-
Mizukawa et al[62]	100 (46/46)	100 (46/46)	100 (46/46)	100 (46/46)	6.52 (3/46)	Cholangitis (n = 3)
Yamada et al[63]	EI-580BT: 100 (163/163) EI-530B: 100 (163/163) Cumulative: 100 (326/326)	EI-580BT: 96 EI-530B: 87 Cumulative: 91.5	-	EI-580BT: 92 (150/163) EI-530B: 89 (145/163) Cumulative: 90.5 (295/326)	EI-580BT: 4.3 (7/163) EI-530B: 6.7 (11/163) Cumulative: 5.5 (18/326)	Pancreatitis (n = 11), Perforation (n = 7)
Nishio et al[52]	95.2 (99/104)	84.5 (81/97)	93.8 (91/97)	97.4 (75/77)	8.7 (9/104)	Cholangitis (n = 5), pancreatitis (n = 2), bleeding (n = 2)
Sato et al[53]	-	-	-	89.2 (91/102)	17.6 (18/102)	Cholangitis (n = 10), Intra-abdominal/retroperitoneal air (n = 6), Bile leakage (n = 1), Bleeding (n = 1)
Sirin and Hulagu[54]	96.8 (30/31)	96.8 (30/31)	87.1 (27/31)	87.1 (27/31)	6 (2/31)	Perforation (n = 1), Retroperitoneal abscess (n = 1)
Uchida et al[32]	94.3 (759/805)	-	-	90.7 (730/805)	5.5 (44/805)	Cholangitis (n = 20) pancreatitis (n = 14), intestinal perforation (n = 6), others (4 cases, including 2 biliary leakage, 1 pancreatic leakage caused by guidewires, and 1 pneumothorax)
Zamora Nava et al[64]	-	77.1 (74/96)	69.8 (67/96)	83.6 (56/67)	14.5 (14/96)	Cholangitis (n = 7), Pancreatitis (n = 2), Perforation (n = 2), Mucosal tear (n = 2), Hemorrhage (n = 1)
CHENG et al[55]	95.7 (44/46)	-	84.1 (37/44)	76.1 (35/46)	13 (6/46)	Intestinal perforation (n = 2), acute cholangitis (n = 3), acute pancreatitis (n = 1)
Obata et al[56]	92.4 (73/79)	81 (64/79)	80 (63/79)	78 (62/79)	5 (4/79)	Bowel perforation (n = 2), pancreatitis (n = 1), hypoxia (n = 1)
Sato et al[57]	100 (20/20)	100 (20/20)	100 (20/20)	100 (20/20)	-	-
Farina et al[65]	69.8 (37/53)	31/37 (83.8)	-	31/37 (84)	0 (0/53)	-
Yokoyama et al[66]	91.3 (264/289)	83.4 (241/289)	-	100 (241/241)	-	-

ERCP: Endoscopic retrograde cholangiopancreatography; DBE: Double-balloon enteroscopy.