{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:51:57Z","timestamp":1791175917567,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This systematic review and meta\u2010analysis evaluated the pooled outcomes and comparative evidence of balloon enteroscopy\u2010assisted ERCP (BEA\u2010ERCP) and EUS\u2010guided biliary drainage (EUS\u2010BD) for malignant biliary obstruction (MBO) in patients with surgically altered anatomy (SAA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Web of Science, and the Cochrane Library were searched up to January 2026. The primary outcome was the pooled technical success rate. Secondary outcomes included the clinical success rate, adverse event rate, recurrent biliary obstruction (RBO) rate, and mean procedure time. Subgroup analyses compared outcomes in studies directly comparing the two procedures. A random\u2010effects model was used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirteen studies were included, comprising nine studies investigating BEA\u2010ERCP (394 patients) and seven investigating EUS\u2010BD (206 patients), including three comparative studies. Pooled technical and clinical success rates were 75% and 72% for BEA\u2010ERCP and 97% and 92% for EUS\u2010BD, respectively. Pooled adverse event rates were 11% for BEA\u2010ERCP and 17% for EUS\u2010BD, and pooled RBO rates were 26% and 23%, respectively. In subgroup analyses of the three comparative studies, technical success rates (risk ratio [RR], 0.74; 95% confidence interval [CI], 0.67\u20130.82) and clinical success rates (RR, 0.70; 95% CI, 0.61\u20130.80) were significantly lower with BEA\u2010ERCP than with EUS\u2010BD, with no significant differences in adverse event rates, RBO rates, or procedural times.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In the three comparative studies, EUS\u2010BD achieved higher technical and clinical success rates than BEA\u2010ERCP for MBO in patients with SAA, with no significant difference in adverse events. These non\u2010randomized findings are preliminary, and large\u2010scale prospective comparative studies are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/den.70309","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:16:37Z","timestamp":1791173797000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Balloon Enteroscopy\u2010Assisted\n                    <scp>ERCP<\/scp>\n                    and\n                    <scp>EUS<\/scp>\n                    \u2010Guided Biliary Drainage for Malignant Biliary Obstruction in Patients With Surgically Altered Anatomy: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0343-7246","authenticated-orcid":false,"given":"Masahiro","family":"Itonaga","sequence":"first","affiliation":[{"name":"Second Department of Internal Medicine Wakayama 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