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Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered gastrointestinal anatomy is challenging. Double-balloon enteroscopy (DBE) has been shown to be safe and efficacious for ERCP in these patients but attempts to synthesize existing data are limited. The purpose of this study was to conduct a systematic review and meta-analysis to evaluate the safety and efficacy of DBE-ERCP in surgically altered anatomy. We searched MEDLINE, EMBASE, and CENTRAL databases through March 2020 for studies tha