Systematic Reviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2019; 25(24): 3091-3107
Published online Jun 28, 2019. doi: 10.3748/wjg.v25.i24.3091
Recent advances in endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: A systematic review
Tae Young Park, Tae Jun Song
Tae Young Park, Department of Internal Medicine, Inje University Seoul Paik Hospital, Seoul 04551, South Korea
Tae Jun Song, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea
Author contributions: Song TJ conceptualized and designed the systematic review; Park TY and Song TJ independently reviewed the included articles; Park TY and Song TJ out the analysis; Park TY drafted the initial manuscript; Song TJ reviewed and approved the final manuscript as submitted.
Conflict-of-interest statement: None of the authors have any conflict of interest relevant to this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
PRISMA 2009 Checklist statement: This systematic review was conducted according to the PRISMA guidelines.
Corresponding author: Tae Jun Song, MD, PhD, Associate Professor, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, South Korea. drsong@amc.seoul.kr
Telephone: +82-2-3010-3194 Fax: +82-2-3010-6517
Received: February 27, 2019
Peer-review started: March 1, 2019
First decision: April 5, 2019
Revised: May 3, 2019
Accepted: May 31, 2019
Article in press: June 1, 2019
Published online: June 28, 2019
Abstract
BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy has been considered a challenging procedure due to the surgically altered gastrointestinal anatomy. However, there has been a paucity of comparative studies regarding ERCP in Billroth II gastrectomy cases because of procedure-related morbidity and mortality and practical and ethical limitations. This systematic and comprehensive review was performed to obtain a recent perspective on ERCP in Billroth II gastrectomy patients.

AIM

To systematically review the literature regarding ERCP in Billroth II gastrectomy patients.

METHODS

A systematic review was performed on the literature published between May 1975 and January 2019. The following electronic databases were searched: PubMed, EMBASE, and Cochrane Library. The outcomes of successful afferent loop intubation and successful selective cannulation and occurrence of adverse events were assessed.

RESULTS

A total of 43 studies involving 2669 patients were included. The study designs were 36 (83.7%) retrospective cohort studies, 4 (9.3%) retrospective comparative studies, 2 (4.7%) prospective comparative studies, and 1 (2.3%) prospective cohort study. Of a total of 2669 patients, there were 1432 cases (55.6%) of side-viewing endoscopy, 664 (25.8%) cases of forward-viewing endoscopy, 171 (6.6%) cases of balloon-assisted enteroscopy, 169 (6.6%) cases of anterior oblique-viewing endoscopy, 64 (2.5%) cases of dual-lumen endoscopy, 31 (1.2%) cases of colonoscopy, and 14 (0.5%) cases of multiple bending endoscopy. The overall success rate of afferent loop intubation was 91.3% (2437/2669), and the overall success rate of selective cannulation was 87.9% (2346/2437). A total of 195 cases (7.3%) of adverse events occurred. The success rates of afferent loop intubation and the selective cannulation rate for each type of endoscopy were as follows: side-viewing endoscopy 98.2% and 95.3%; forward-viewing endoscopy 97.4% and 95.2%; balloon-assisted enteroscopy 95.4% and 97.5%; oblique-viewing endoscopy 94.1% and 97.5%; and dual-lumen endoscopy 82.8% and 100%, respectively. The rate of bowel perforation was slightly higher in side-viewing endoscopy (3.6%) and balloon-assisted enteroscopy (4.1%) compared with forward-viewing endoscopy (1.7%) and anterior oblique-viewing endoscopy (1.2%). Mortality only occurred in side-viewing endoscopy (n = 9, 0.6%).

CONCLUSION

The performance of ERCP in the Billroth II gastrectomy population has been improving with choice of various type of endoscope and sphincter management. More comparative studies are needed to determine the optimal strategy to perform safe and effective ERCP in Billroth II gastrectomy patients.

Keywords: Endoscopic retrograde, Cholangiopancreatography, Therapeutic, Endoscope, Billroth II operation, Adverse event, Systematic review

Core tip: Endoscopic retrograde cholangiopancreatography (ERCP) in Billroth II gastrectomy anatomy has been considered a difficult procedure due to the surgical alteration. To date, there has been a paucity of comparative studies regarding ERCP in Billroth II gastrectomy patients. In current study, we systematically and comprehensively reviewed the literatures regarding ERCP in Billroth II gastrectomy cases. The performance of ERCP in the Billroth II gastrectomy has been improving with choice of various type of endoscope and sphincter therapy. More comparative studies are required to perform effective and safe ERCP in Billroth II gastrectomy population.