Forward-viewing endoscopy with cap-fitting versus side-viewing duodenoscope for ERCP in Billroth II gastrectomy: a systematic review and meta-analysis

BACKGROUND AND AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy remains technically challenging. Although both the conventional side-viewing duodenoscope and the forward-viewing endoscope with a distal cap are used in this setting, comparative evidence specifically assessing the role of the distal cap is limited. This study represents the first systematic review and meta-analysis comparing the efficacy and safety of cap-assisted forward-viewing endoscopy versus side-viewing duodenoscopy for ERCP in patients with Billroth II anatomy. METHODS: statistic. Analyses were performed on both a per-patient and per-procedure basis. Findings were consistent across per-patient and per-procedure analyses. CONCLUSIONS: Cap-assisted forward-viewing endoscopy and side-viewing duodenoscopy showed similar efficacy for ERCP in patients with Billroth II gastrectomy. Although no statistically significant differences were observed in major adverse events, these findings should be interpreted with caution because limited statistical power may have obscured clinically relevant differences. Current evidence does not support a firm conclusion regarding equivalence or superiority of either approach, and larger comparative studies are needed to better define their relative efficacy and safety.