Systematic Reviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2019; 25(24): 3091-3107
Published online Jun 28, 2019. doi: 10.3748/wjg.v25.i24.3091
Recent advances in endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: A systematic review
Tae Young Park, Tae Jun Song
Tae Young Park, Department of Internal Medicine, Inje University Seoul Paik Hospital, Seoul 04551, South Korea
Tae Jun Song, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea
Author contributions: Song TJ conceptualized and designed the systematic review; Park TY and Song TJ independently reviewed the included articles; Park TY and Song TJ out the analysis; Park TY drafted the initial manuscript; Song TJ reviewed and approved the final manuscript as submitted.
Conflict-of-interest statement: None of the authors have any conflict of interest relevant to this study.
Open-Access: 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/
PRISMA 2009 Checklist statement: This systematic review was conducted according to the PRISMA guidelines.
Corresponding author: Tae Jun Song, MD, PhD, Associate Professor, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, South Korea. drsong@amc.seoul.kr
Telephone: +82-2-3010-3194 Fax: +82-2-3010-6517
Received: February 27, 2019
Peer-review started: March 1, 2019
First decision: April 5, 2019
Revised: May 3, 2019
Accepted: May 31, 2019
Article in press: June 1, 2019
Published online: June 28, 2019
ARTICLE HIGHLIGHTS
Research background

Endoscopic retrograde cholangiopancreatography (ERCP) in patients who have a Billroth II gastrectomy has been considered a difficult procedure due to the surgically altered anatomy. The difficulties of ERCP in patients with Billroth II gastrectomy include the intubation of the afferent loop, visualization of the papilla, selective cannulation of the bile duct, and optimal sphincter management due to the reverse direction of the papilla. To perform safe and effective ERCP in Billroth II gastrectomy cases, considerable efforts have been put in several ways including the choice of endoscope and sphincter management. However, there has been a paucity of comparative studies on the efficacy and safety regarding ERCP in Billroth II gastrectomy.

Research motivation

At present, comparative studies on the efficacy and safety of ERCP in Billroth II gastrectomy cases are lacking because of practical and ethical limitations due to procedure-related morbidity and mortality. This systematic and comprehensive review was performed to obtain a recent perspective on ERCP in Billroth II gastrectomy patients.

Research objectives

The main objective of the study was to assess the efficacy and safety of ERCP in Billroth II gastrectomy patients. In detail, the assessment of success rate of afferent loop intubation and selective cannulation, and rate of adverse events including bowel perforation, post-ERCP pancreatitis, bleeding, cardiopulmonary events, and mortality was performed. In addition, the assessment of these outcomes according to each type of endoscopy and sphincter management methods was performed.

Research methods

A systematic review was performed on the literatures that evaluated the outcomes of ERCP in Billroth II gastrectomy patients. Electronic databases were searched, including PubMed, EMBASE, and Cochrane Library. The outcomes of afferent loop intubation and selective cannulation, and occurrence of adverse events were assessed.

Research results

A total of 43 studies involving 2669 patients were included. The overall success rate of afferent loop intubation was 91.3% (2437/2669), and the overall success rate of selective cannulation was 87.9% (2346/2437). A total of 195 cases (7.3%) of adverse events occurred. Bowel perforations occurred in 74 cases (2.8%), post-ERCP pancreatitis in 65 cases (2.4%), bleeding in 37 cases (1.4%), mortality in 9 cases (0.3%).

Research conclusions

This systematic review showed that the performance of ERCP in the Billroth II gastrectomy patients has been improving with choice of endoscope and sphincter management. To determine the optimal method to perform safe and effective ERCP in Billroth II gastrectomy patients, more comparative studies are needed in the future.

Research perspectives

The success of ERCP in Billroth II gastrectomy has been improving with technical advance. Future research is needed to explore the optimal approach in performance of ERCP in Billroth II gastrectomy cases.