{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T09:13:45Z","timestamp":1777972425040,"version":"3.51.4"},"reference-count":40,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy (SAA) presents significant technical challenges due to altered bowel reconstructions. Endoscopic peroral cholangioscopy (POC) offers a less invasive alternative to percutaneous or transmural techniques, but robust evidence validating its performance in SAA is lacking. This systematic review and meta-analysis (SRMA) aims to evaluate the feasibility and safety of endoscopic POC as a primary strategy in SAA. Methods: A systematic search was performed on PubMed and Embase up to December 2025 for studies reporting cholangioscopic outcomes in SAA patients utilizing an endoscopic approach. The primary outcome was the cholangioscopic access rate (AR). Secondary outcomes included endoscopic success rate (SR), technical SR, and adverse events. Pooled rates were calculated using Generalized Linear Mixed Models (GLMM). Results: Eight studies comprising 469 patients were included. The pooled endoscopic SR was 86.7% (95% CI, 74.4\u201393.6%) but showed high heterogeneity (I2 = 79.9%), largely driven by the variation in anatomical reconstructions. Subgroup analysis revealed higher endoscopic SR in short-limb anatomies (86.5%) compared to long-limb configurations (76.2%). Conversely, once biliary cannulation was achieved, the procedure was highly reliable: the pooled cholangioscopic AR was 95.9% (95% CI, 78.7\u201399.3%), with no significant difference across anatomical subgroups. The pooled adverse event rate was 3.1% (95% CI, 1.3\u20136.8%), predominantly characterized by mild complications. Conclusions: Endoscopic POC is a feasible and safe technique for managing biliary disease in SAA. The procedure\u2019s overall success appears to be strictly dependent on the ability to navigate the altered anatomy (endoscopic phase), whereas the cholangioscopic phase itself proves highly effective and reproducible once biliary access is secured.<\/jats:p>","DOI":"10.3390\/jcm15093514","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T07:57:29Z","timestamp":1777967849000},"page":"3514","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility and Safety of Endoscopic Peroral Cholangioscopy in Surgically Altered Anatomy: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"given":"Noemi","family":"Gualandi","sequence":"first","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, 41012 Carpi, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8793-5890","authenticated-orcid":false,"given":"Pablo","family":"Cortegoso Valdivia","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, University Hospital of Parma, 43126 Parma, Italy"},{"name":"Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark"},{"name":"Surgical Research Unit, Odense University Hospital og Svendborg Sygehus, 5700 Svendborg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuliano Francesco","family":"Bonura","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, 41012 Carpi, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8457-2994","authenticated-orcid":false,"given":"Tommaso","family":"Gabbani","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, 41012 Carpi, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Soriani","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, 41012 Carpi, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauro","family":"Manno","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, 41012 Carpi, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1055\/a-2619-8434","article-title":"Quality Standards and Curriculum for Training in Cholangiopancreatoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement","volume":"57","author":"Johnson","year":"2025","journal-title":"Endoscopy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1055\/a-0862-0346","article-title":"Endoscopic Management of Common Bile Duct Stones: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"51","author":"Manes","year":"2019","journal-title":"Endoscopy"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1055\/a-2481-7048","article-title":"Diagnostic Work-up of Bile Duct Strictures: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"57","author":"Facciorusso","year":"2025","journal-title":"Endoscopy"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3822","DOI":"10.1007\/s11695-020-04703-0","article-title":"Comparison of Surgical Activity and Scientific Publications in Bariatric Surgery: An Epidemiological and Bibliometric Analysis","volume":"30","author":"Paolino","year":"2020","journal-title":"Obes. 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