P4466 - EUS-Guided Antegrade Treatment vs Balloon Enteroscopy ERCP for Choledocholithiasis in Patients With Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis

Amna Iqbal, MD¹, Zohaib Ahmed, MD¹, Muhammad Aziz, MD², Manesh Kumar Gangwani, MD³, Dushyant S. Dahiya, MD⁴, Hassam Ali, MD⁵, Abdullah Sohail, MD⁶, Umar Hayat, MD⁷, Shailendra Singh, MD⁸, Babu Mohan, MD⁹, Toseef Javaid, MD¹⁰, Ali Nawras, MD^1
1University of Toledo Medical Center, Toledo, OH; ²Bon Secours Mercy, Toledo, OH; ³University of Toledo, Toledo, OH; ⁴The University of Kansas School of Medicine, Kansas City, KS; ⁵East Carolina University, Greenville, NC; ⁶University of Iowa Hospitals & Clinics, Iowa City, IA; ⁷Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA; ⁸West Virginia University, Morgantown, WV; ⁹Orlando Gastroenterology PA, Orlando, FL; ¹⁰United Health Services, Wilson Medical Center, Johnson City, NY

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 two procedures.

Methods: A systematic search of multiple databases was undertaken through January 25, 2024 to identify relevant studies comparing the two 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%). (Fig.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 %). (Fig. 1b) Other outcomes like rates of clinical success (RR:0.95, CI: 0.75-1.18, P=0.62, I ²= 33%) (Fig.1c), pancreatitis (RR: 0.34, CI: 0.04-2.55, P= 0.29, I ²= 0%) (Fig.1d), perforation (RR: 0.38, CI: 0.05-2.80, P= 0.34, I²= 0%) (Fig.1e), and bile peritonitis (RR: 7.66, CI: 0.54-108.94, P= 0.13, I²= 37%) (Fig.1f) were similar between the two procedure techniques.

Discussion: 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.



Disclosures:


Amna Iqbal, MD¹, Zohaib Ahmed, MD¹, Muhammad Aziz, MD², Manesh Kumar Gangwani, MD³, Dushyant S. Dahiya, MD⁴, Hassam Ali, MD⁵, Abdullah Sohail, MD⁶, Umar Hayat, MD⁷, Shailendra Singh, MD⁸, Babu Mohan, MD⁹, Toseef Javaid, MD¹⁰, Ali Nawras, MD¹. P4466 - EUS-Guided Antegrade Treatment vs Balloon Enteroscopy ERCP for Choledocholithiasis in Patients With Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.