DBE-ERCP resolves hepaticojejunostomy strictures in most patients, but recurrence remains commonScope Procedure Reopens Bile Duct Blockages in Most Patients

Surgical endoscopy Published October 6, 2026 Study authors: Li Huaqi, Khalaf Kareem, Yuan Yuhong, Bucheeri Mohamed, Brar Gurmun, Devloo Rianne, Zheng Katina, Hu… PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider DBE-ERCP for HJAS, but note 36% recurrence and limited long-term data.

This meta-analysis evaluated double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (DBE-ERCP) for hepaticojejunostomy anastomotic strictures (HJAS) in 386 patients. The authors pooled data on technical success, clinical success (stricture-sustained resolution), recurrence, and adverse events.

Technical success was achieved in 86% of procedures (95% CI 79-92%). Among 346 patients with technically successful procedures, clinical success was 78% (95% CI 63-88%). Recurrence occurred in 36% of 220 patients (95% CI 22-52%). Adverse events were reported in 15% of cases; serious adverse events and discontinuations were not reported.

The authors note that long-term outcome data are lacking, which limits conclusions about durability. The comparator was not reported, and the setting and follow-up duration were not described. Funding and conflicts of interest were not reported.

In practice, DBE-ERCP appears technically feasible and leads to stricture resolution in most patients after the first procedure, with an acceptable adverse event profile. However, the high recurrence rate and absence of long-term data suggest that patients may require ongoing surveillance and repeat interventions. These findings are based on pooled observational data and should be interpreted with caution.

A new analysis pooled results from patients with narrowed bile duct connections after surgery, a problem called hepaticojejunostomy anastomotic strictures. The review included 386 patients and looked at a procedure called double-balloon enteroscopy-assisted ERCP, or DBE-ERCP, which uses a special scope to reach the blocked area.

The procedure was technically successful in 86% of cases (95% CI 79-92%). Among the 346 patients where the scope reached the blockage, 78% had their stricture resolved (95% CI 63-88%). However, the narrowing came back in 36% of 220 patients (95% CI 22-52%). Adverse events occurred in 15% of cases.

The main caution is that long-term outcome data are lacking. This means we do not know how well the procedure works over many years or whether repeat procedures are needed. The analysis did not compare DBE-ERCP to other treatments, so it is unclear if it is better or worse than alternatives.

For patients with this condition, DBE-ERCP appears to be an option that often works at least in the short term, but the chance of recurrence and the lack of long-term data are important to discuss with a doctor.

What this means for you:

Special scope opens blocked bile ducts in most patients, but blockage returns in about a third.

Common questions

How successful is DBE-ERCP for bile duct strictures?

In this analysis of 386 patients, the procedure was technically successful in 86% of cases. Among those, 78% had their stricture resolved. However, the blockage returned in 36% of patients, so success is not permanent for everyone.

What are the side effects of DBE-ERCP?

Adverse events occurred in 15% of cases. The analysis did not report serious adverse events or discontinuations separately. Your doctor can explain what specific risks might apply to your situation.

Does the stricture come back after DBE-ERCP?

Yes, recurrence happened in 36% of 220 patients in this analysis. That means about one in three patients saw the narrowing return. Long-term data are lacking, so it is unclear how often this happens over many years.

Who is DBE-ERCP for?

This procedure is for patients with hepaticojejunostomy anastomotic strictures, which are narrowed bile duct connections after surgery. The analysis included 386 such patients. Talk to your doctor to see if this option fits your case.

Study Details

Study typeMeta analysis

Sample sizen = 386

EvidenceLevel 1

PublishedOct 2026

PMID42680928

View Original 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.

DBE-ERCP resolves hepaticojejunostomy strictures in most patients, but recurrence remains commonScope Procedure Reopens Bile Duct Blockages in Most Patients

Common questions

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DBE-ERCP resolves hepaticojejunostomy strictures in most patients, but recurrence remains commonScope Procedure Reopens Bile Duct Blockages in Most Patients

Common questions

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