Abstract
S1619 EUS-Guided Antegrade Treatment vs Balloon Enteroscopy ERCP for Choledocholithiasis in Patients With Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis
The American journal of gastroenterology, Vol.119(10S), pp.S1176-S1177
10/2024
DOI: 10.14309/01.ajg.0001035844.44745.92
Abstract
Introduction:
The safety and technical success of Endoscopic ultrasound (EUS) guided antegrade treatment (EUS-AG) compared to Balloon enteroscopy assisted endoscopic cholangiopancreatography (BE-ERCP) for choledocholithiasis in Roux en Y gastrectomy has not been well documented. We performed a systematic review and meta-analysis of available studies to assess the safety and efficacy of the 2 procedures.
Methods:
A systematic search of multiple databases was undertaken through January 25, 2024 to identify relevant studies comparing the 2 procedures. Standard meta-analysis methods were employed using the random effects model. For each outcome, risk-ratio (RR), 95 % confidence interval (CI), and P values were generated. P < 0.05 was considered significant. Heterogeneity was assessed using the I2% statistics.
Results:
3 studies with 795 patients (95 in the EUS-AG group and 700 in the BE-ERCP group) were included. The technical success rate was similar between EUS-AG and BE-ERCP (RR: 1.08, CI: 0.84-1.38, P = 0.57, I 2 = 56%). (Figure 1a) The overall side effects rate was higher in BE-ERCP group compared to EUS-AG (RR: 1.95, CI: 1.21-3.15, P = 0.006, I 2 = 0 %). (Figure 1b) Other outcomes like rates of clinical success (RR:0.95, CI: 0.75-1.18, P=0.62, I 2= 33%) (Figure 1c), pancreatitis (RR: 0.34, CI: 0.04-2.55, P= 0.29, I 2= 0%) (Figure 1d), perforation (RR: 0.38, CI: 0.05-2.80, P= 0.34, I2= 0%) (Figure 1e), and bile peritonitis (RR: 7.66, CI: 0.54-108.94, P= 0.13, I2= 37%) (Figure 1f) were similar between the 2 procedure techniques.
Conclusion:
Our analysis showed no distinct advantage in using one technique over the other for patients with RYGB in achieving technical and clinical success. The incidence of adverse effects was greater in the BE-ERCP group than in EUS-AG group. A recent retrospective analysis by Gerson et al. Demonstrated that double balloon enteroscopy is associated with a higher complication rate compared with standard endoscopic procedures. The perforation rate was significantly elevated in patients with altered surgical anatomy undergoing diagnostic retrograde double balloon enteroscopy. Itoi et al. report a technical success rate of 60% with EUS-AG technique in a recent case series of patients with surgically altered anatomy and choledocholithiasis. Our study suggests that both techniques are equally viable options for endoscopic intervention in Roux-en-Y anatomy, allowing for flexibility in clinical decision-making based on the practitioner's expertise and the specific circumstances of each case.
Details
- Title: Subtitle
- S1619 EUS-Guided Antegrade Treatment vs Balloon Enteroscopy ERCP for Choledocholithiasis in Patients With Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis
- Creators
- Amna Iqbal - University of Toledo Medical CenterZohaib Ahmed - University of Toledo Medical CenterMuhammad AzizManesh Kumar Gangwani - University of ToledoDushyant S. Dahiya - University of KansasHassam Ali - East Carolina UniversityAbdullah Sohail - University of IowaUmar Hayat - Geisinger Wyoming Valley Medical CenterShailendra Singh - West Virginia UniversityBabu Mohan - Orlando Gastroenterology PA, Orlando, FLToseef Javaid - United Health ServicesAli Nawras - University of Toledo Medical Center
- Resource Type
- Abstract
- Publication Details
- The American journal of gastroenterology, Vol.119(10S), pp.S1176-S1177
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- DOI
- 10.14309/01.ajg.0001035844.44745.92
- ISSN
- 0002-9270
- eISSN
- 1572-0241
- Language
- English
- Date published
- 10/2024
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984740059502771
Metrics
2 Record Views