Comparison of clinical outcomes for single- and double-balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

doi:10.3748/wjg.v31.i41.111022

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Nov 7, 2025; 31(41): 111022
Published online Nov 7, 2025. doi: 10.3748/wjg.v31.i41.111022

Comparison of clinical outcomes for single- and double-balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

Sung Yong Han, Min Jae Yang, Kyong Joo Lee, Jonghyun Lee, Se Woo Park

Sung Yong Han, Jonghyun Lee, Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea

Min Jae Yang, Department of Gastroenterology, Ajou University School of Medicine, Suwon 16499, South Korea

Kyong Joo Lee, Se Woo Park, Department of Internal Medicine, Hallym University College of Medicine, Hwaseong-si 18450, South Korea

Co-corresponding authors: Min Jae Yang and Se Woo Park.

Author contributions: Yang MJ and Park SW are the guarantors of the article, designed the research study, and made equal contributions as co-corresponding authors; Yang MJ, Han SY, and Park SW acquired the data, drafted the manuscript, critically revised the manuscript for important intellectual content, performed the statistical analysis, and supervised the study; all authors analyzed and interpreted the data, approved the final version of the article.

Supported by National Research Foundation of Korea, No. RS-2022-NRO71822; and Hallym University Medical Center Research Fund (Mighty Hallym, 4.0).

Institutional review board statement: The study conformed to the ethical guidelines of the Declaration of Helsinki and received ethical approval from the Institutional Review Boards of Hallym University Hospital, No. 2022-04-008.

Informed consent statement: The study protocol was approved by the Institutional Review Board, and the requirement for informed consent was waived due to the retrospective nature of the study.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The data that support the findings of this study are not publicly available, as they are proprietary to the corresponding author; however, detailed summaries and analyses are provided within the article and its Supplementary material.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Se Woo Park, MD, PhD, Department of Internal Medicine, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong-si 18450, South Korea. mdsewoopark@gmail.com

Received: June 23, 2025
Revised: August 3, 2025
Accepted: September 29, 2025
Published online: November 7, 2025
Processing time: 138 Days and 20.8 Hours

Abstract

BACKGROUND

Balloon-assisted enteroscopy with a specialized overtube has improved the success of endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy (SAA). However, direct comparative data between double-balloon enteroscopy (DBE) and single-balloon enteroscopy (SBE) remain limited.

AIM

To compare the ERCP-related outcomes between DBE and SBE in patients with SAA.

METHODS

We retrospectively reviewed the medical records of 1042 patients with SAA who underwent ERCP. After propensity score matching for age and sex, 494 patients were included, with 247 patients in each of the SBE and DBE groups.

RESULTS

The success rates of intubation, cannulation, completion of intended ERCP, and adverse events were similar between the DBE and SBE groups (94.3% vs 96.4%, P = 0.393; 89.5% vs 93.5%, P = 0.147; 88.3% vs 92.7%, P = 0.125; 10.5% vs 14.6%, P = 0.222, respectively). However, the SBE group had significantly longer intubation and procedure times than the DBE group (23.5 ± 22.3 minutes vs 14.1 ± 13.5 minutes, P < 0.001; 65.2 ± 37.9 minutes vs 31.0 ± 18.5 minutes, P < 0.001). Preserved gastric anatomy and Roux-en-Y reconstruction were independently associated with intubation failure (odds ratio = 3.18, 95% confidence interval: 1.30-8.31; odds ratio = 8.65, 95% confidence interval: 1.71-157.60, respectively).

CONCLUSION

DBE and SBE showed comparable clinical success and safety profiles in ERCP for patients with SAA, although SBE required significantly longer procedure times. DBE could provide procedural efficiency benefits in cases where an extended procedure duration is expected. Furthermore, a preserved gastric anatomy and Roux-en-Y reconstruction were identified as independent risk factors for intubation failure.

Keywords: Cholangiopancreatography; Endoscopic retrograde; Single-balloon enteroscopy; Double-balloon enteroscopy; Digestive system surgical procedures; Anastomosis; Surgical

Core Tip: This multicenter retrospective study compared the performance of double-balloon enteroscopy (DBE) and single-balloon enteroscopy for enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy. While both techniques showed comparable success and adverse event rates, DBE demonstrated significantly shorter intubation and total procedure times. Furthermore, preserved gastric anatomy and Roux-en-Y reconstruction were identified as risk factors for intubation failure. These findings offer insight into the optimal selection of enteroscopy systems in surgically altered anatomy cases and highlight the potential procedural efficiency of DBE in anatomically complex settings.