Sun GY, Liu ZX, Sun Y, Yang Z. Efficacy and safety of double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in surgically altered anatomy: A systematic review and meta-analysis. World J Gastrointest Endosc 2025; 17(11): 112348 [PMID: 41256298 DOI: 10.4253/wjge.v17.i11.112348]
Corresponding Author of This Article
Zhuo Yang, Chief Physician, Professor, Department of Endoscopy, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110000, Liaoning Province, China. yangzhuocy@163.com
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Gastroenterology & Hepatology
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Meta-Analysis
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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/
Nov 16, 2025 (publication date) through Dec 19, 2025
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World Journal of Gastrointestinal Endoscopy
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1948-5190
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Sun GY, Liu ZX, Sun Y, Yang Z. Efficacy and safety of double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in surgically altered anatomy: A systematic review and meta-analysis. World J Gastrointest Endosc 2025; 17(11): 112348 [PMID: 41256298 DOI: 10.4253/wjge.v17.i11.112348]
World J Gastrointest Endosc. Nov 16, 2025; 17(11): 112348 Published online Nov 16, 2025. doi: 10.4253/wjge.v17.i11.112348
Efficacy and safety of double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in surgically altered anatomy: A systematic review and meta-analysis
Guo-Yao Sun, Zhi-Xin Liu, Yong Sun, Zhuo Yang
Guo-Yao Sun, Zhi-Xin Liu, Yong Sun, Zhuo Yang, Department of Endoscopy, General Hospital of Northern Theater Command, Shenyang 110000, Liaoning Province, China
Co-first authors: Guo-Yao Sun and Zhi-Xin Liu.
Co-corresponding authors: Yong Sun and Zhuo Yang.
Author contributions: Sun GY contributed to data curation and visualization; Liu ZX performed formal analysis and software development; and Sun Y and Yang Z was responsible for conceptualization and supervision. Sun GY and Liu ZX have contributed equally to this work. Sun Y and Yang Z served as the principal investigators of this study, providing overall conceptual guidance, supervision of experimental design, and oversight of data interpretation. They were responsible for critical decisions regarding methodology, study direction, and manuscript preparation. Their leadership ensured the scientific rigor and integrity of the research, and both authors contributed equally to the supervision and finalization of the manuscript. Therefore, designating them as co-corresponding authors appropriately reflects their shared responsibility in guiding the study and correspondence with the journal.
Supported by Department of Science and Technology of Liaoning Province, No. 2024JH2/102600288 and No. 2022JH2/101500013.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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: Zhuo Yang, Chief Physician, Professor, Department of Endoscopy, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110000, Liaoning Province, China. yangzhuocy@163.com
Received: July 24, 2025 Revised: September 8, 2025 Accepted: October 21, 2025 Published online: November 16, 2025 Processing time: 113 Days and 12.8 Hours
Abstract
BACKGROUND
Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered gastrointestinal anatomy poses significant challenges. Double-balloon enteroscopy-assisted ERCP (DBE-ERCP) has emerged as a safe and effective approach in this patient population. This study aims to provide an updated systematic review and meta-analysis of the safety and efficacy of DBE-ERCP in patients with surgically altered anatomy (SAA), building on previously published evidence.
AIM
To evaluate the safety and efficacy of DBE-ERCP in patients with SAA through an updated systematic review and meta-analysis and to compare outcomes between short- and long-scope double-balloon enteroscopy (DBE).
METHODS
A comprehensive search of PubMed, EMBASE, and Web of Science was performed for studies published up to March 2025 investigating DBE-ERCP in patients with surgically altered gastrointestinal anatomy. A random-effects model was applied to conduct a meta-analysis of proportions. The risk of bias was evaluated using the Newcastle-Ottawa Scale and the Joanna Briggs Institute Scale. Heterogeneity was evaluated using the inconsistency statistic (I2). Publication bias was examined using funnel plots and Egger’s regression test.
RESULTS
A total of 40 studies were included, comprising 10 cohort studies and 30 case series, including 2689 patients who underwent 3478 procedures. The surgical procedures were primarily classified into three categories: Roux-en-Y reconstruction (including hepaticojejunostomy, gastric bypass, and choledochojejunostomy, etc.) in 1156 cases; pancreaticoduodenectomy (performed using either the Whipple or Child technique) in 549 cases; and Billroth II anastomosis in 265 cases. The combined success rate for reaching the papilla was 92% (95%CI: 89%-95%). The overall enteroscopy success rate was 89% (95%CI: 85%-92%). The pooled diagnostic success rate was 90% (95%CI: 85%-95%), while the therapeutic success rate reached 92% (95%CI: 89%-95%). Adverse events reported in 5.7% of patients (95%CI: 4.1%-7.5%). Subgroup analysis comparing short-scope and long-scope demonstrated that the short DBE was superior in terms of papilla reached rate, enteroscopy success, and procedural success. No significant differences were observed between groups in diagnostic success or adverse events.
CONCLUSION
DBE-ERCP demonstrates both safety and efficacy in patients with SAA. Compared to long-scope DBE, short-scope DBE shows greater clinical promise; however, further randomized controlled trials are warranted to validate these findings.
Core Tip: Double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (DBE-ERCP) is a safe and effective approach for the management of pancreatobiliary diseases in patients with surgically altered anatomy. This updated systematic review and meta-analysis of 40 studies including 2689 patients demonstrates high enteroscopic (89%), diagnostic (90%), and procedural (92%) success rates, with a low overall adverse event rate (5.7%). Subgroup analysis indicates that short-type double-balloon enteroscopy (DBE) outperforms long-type DBE in procedural success and papilla access. These findings highlight the clinical utility of DBE-ERCP and suggest that short-type DBE may offer greater advantages, though further randomized controlled trials are warranted.
