Huaqi Li, Kareem Khalaf, Yuhong Yuan, Mohamed Bucheeri, Gurmun Brar, Rianne Devloo, Katina Zheng, Malini Hu, Christopher W Teshima, Jeffrey D Mosko, Gary R May, Natalia Causada Calo
DBE-ERCP for the treatment of HJAS is technically successful in close to 90% of cases and appears to lead to stricture resolution in most patients after the first procedure, although long-term outcome data are lacking. In addition, the procedure is associated with an acceptable adverse event profile. Future research should explore long-term outcomes and predictors of procedure outcomes to aid in decision making.
BACKGROUND AND AIMS: Patients with hepaticojejunostomy anastomotic strictures (HJAS) may be challenging to manage due to altered surgical anatomy, which precludes conventional endoscopic retrograde cholangiopancreatography (ERCP). Double-balloon enteroscopy-assisted ERCP (DBE-ERCP) is a minimally invasive approach for managing HJAS and previous studies have reported variable technical and clinical success rates. This systematic review and meta-analysis aimed to assess overall clinical success, defined as stricture-sustained resolution, and HJAS recurrence following index DBE-ERCP. Additional outcomes included technical success and associated adverse events.
METHODS: A comprehensive literature search of MEDLINE, Embase, and Cochrane CENTRAL (via Ovid) was conducted from inception to November 2024. The study protocol was registered in the PROSPERO database (CRD42024612553). Eligible studies included randomized controlled trials, non-randomized controlled trials, and observational cohort studies reporting on DBE-ERCP outcomes for HJAS. Pooled estimates for technical and clinical success, recurrence rates, and adverse events were calculated using random-effects models.
RESULTS: Six studies comprising 386 patients met inclusion criteria. Pooled technical success rate of DBE-ERCP was 86% (95% CI 79-92%). Among 346 patients with technically successful procedures, clinical success was achieved in 78% (95% CI 63-88%). Adverse events occurred in 15% of cases among 345 patients (95% CI 5-36%). Five studies reported recurrence rate among 220 patients. Pooled incidence of recurrence was 36% (95% CI 22-52%).
CONCLUSIONS: DBE-ERCP for the treatment of HJAS is technically successful in close to 90% of cases and appears to lead to stricture resolution in most patients after the first procedure, although long-term outcome data are lacking. In addition, the procedure is associated with an acceptable adverse event profile. Future research should explore long-term outcomes and predictors of procedure outcomes to aid in decision making.