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- Title
Forward-viewing endoscope for ERCP in patients with Billroth II gastrectomy: a systematic review and meta-analysis.
- Authors
Park, Tae Young; Bang, Chang Seok; Choi, Sang Hyeon; Yang, Young Joo; Shin, Suk Pyo; Suk, Ki Tae; Baik, Gwang Ho; Kim, Dong Joon; Yoon, Jai Hoon
- Abstract
<bold>Background: </bold>The forward-viewing endoscope has been increasingly used to perform endoscopic retrograde cholangiopancreatography (ERCP) in patients who underwent Billroth II gastrectomy. This study intended to assess efficacy and safety of the forward-viewing endoscope for ERCP in Billroth II gastrectomy patients compared with conventional side-viewing endoscope using a systematic review and meta-analysis.<bold>Methods: </bold>A systematic review was conducted for studies that evaluated the outcomes of ERCP for patients with Billroth II gastrectomy. Random-effect model meta-analyses with subgroup analyses were conducted. The methodological quality of the included publications was evaluated using the risk of bias assessment tool for non-randomized studies. The publication bias was assessed.<bold>Results: </bold>In total, 25 studies (1 randomized, 18 retrospective, 1 prospective, and 5 case series studies) with 2446 patients (499 forward-viewing and 1947 side-viewing endoscopes) were analyzed. The pooled afferent loop intubation rate was higher with the forward-viewing endoscope (90.3%, 95% confidence interval (CI) 85.6-93.6 vs. 86.8%, 95% CI 82.8-89.9%). The pooled selective cannulation rate was higher with the side-viewing endoscope (92.3%, 95% CI 88.0-95.2 vs. 91.1%, 95% CI 87.2-93.9%). The pooled bowel perforation rate was higher with the side-viewing endoscope (3.6%, 95% CI 2.3-5.7 vs. 3.0%, 95% CI 1.7-5.3%). The pooled pancreatitis rate was higher with the forward-viewing endoscope (5.4%, 95% CI 3.6-8.0 vs. 2.5%, 95% CI 2.3-5.7%). The pooled bleeding rate was higher with the forward-viewing endoscope (3.0%, 95% CI 1.6-5.5 vs. 2.0%, 95% CI 1.4-3.0%). The heterogeneity among the studies was not significant. The publication bias was minimal.<bold>Conclusion: </bold>This meta-analysis indicates that the forward-viewing endoscope is as safe and effective as conventional side-viewing endoscope for ERCP in patients with Billroth II gastrectomy.
- Subjects
GASTRECTOMY; META-analysis; ENDOSCOPIC retrograde cholangiopancreatography; RANDOMIZED controlled trials; GASTRIC intubation
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2018, Vol 32, Issue 11, p4598
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-018-6213-1