Efficacy of double-balloon enteroscopy-endoscopic retrograde cholangiopancreatography for hepaticojejunostomy strictures: a systematic review and meta-analysis
In brief
Double-balloon enteroscopy ERCP resolves hepaticojejunostomy strictures in about three-quarters of patients
In a meta-analysis of six studies (386 patients), DBE-ERCP achieved technical success in roughly 86% of attempts and led to sustained stricture resolution in 78% of those cases. Recurrence occurred in about one-third of patients, while adverse events were seen in 15%, indicating an acceptable safety profile but highlighting the need for longer-term data.
- Journal
- Surgical endoscopy (Q1)
- Published
- 1 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Huaqi Li, Kareem Khalaf, Yuhong Yuan, Mohamed Bucheeri, Gurmun Brar, Rianne Devloo, et al.
- PMID
- 42680928
- DOI
- 10.1007/s00464-026-13283-6
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 6 September 2026): DBE‑ERCP for hepaticojejunostomy strictures meta‑analysis
- Picked for Gastroenterology (top studies of the week, 6 September 2026): Meta-analysis of DBE‑ERCP for hepaticojejunostomy strictures
Abstract
BACKGROUND AND AIMS: Patients with hepaticojejunostomy anastomotic strictures (HJAS) may be challenging to manage due to altered surgical anatomy, which precludes conventional endoscopic retrograde cholangiopancreatography (ERCP). Double-balloon enteroscopy-assisted ERCP (DBE-ERCP) is a minimally invasive approach for managing HJAS and previous studies have reported variable technical and clinical success rates. This systematic review and meta-analysis aimed to assess overall clinical success, defined as stricture-sustained resolution, and HJAS recurrence following index DBE-ERCP. Additional outcomes included technical success and associated adverse events. METHODS: A comprehensive literature search of MEDLINE, Embase, and Cochrane CENTRAL (via Ovid) was conducted from inception to November 2024. The study protocol was registered in the PROSPERO database (CRD42024612553). Eligible studies included randomized controlled trials, non-randomized controlled trials, and observational cohort studies reporting on DBE-ERCP outcomes for HJAS. Pooled estimates for technical and clinical success, recurrence rates, and adverse events were calculated using random-effects models. RESULTS: Six studies comprising 386 patients met inclusion criteria. Pooled technical success rate of DBE-ERCP was 86% (95% CI 79-92%). Among 346 patients with technically successful procedures, clinical success was achieved in 78% (95% CI 63-88%). Adverse events occurred in 15% of cases among 345 patients (95% CI 5-36%). Five studies reported recurrence rate among 220 patients. Pooled incidence of recurrence was 36% (95% CI 22-52%). CONCLUSIONS: DBE-ERCP for the treatment of HJAS is technically successful in close to 90% of cases and appears to lead to stricture resolution in most patients after the first procedure, although long-term outcome data are lacking. In addition, the procedure is associated with an acceptable adverse event profile. Future research should explore long-term outcomes and predictors of procedure outcomes to aid in decision making.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.