Forward-viewing endoscopy with a cap shows similar efficacy to side-viewing duodenoscopy for ERCP in Billroth II patients.

• No significant differences in biliary cannulation or clinical success rates between the two techniques.
• Adverse event rates were comparable; however, post-ERCP pancreatitis rates were higher with the forward-viewing approach (14.5% vs 6.7%).

Surgeons should interpret these findings cautiously due to limited sample sizes and consider patient selection when choosing techniques.

• Larger studies are needed for clearer insights into the safety and efficacy of these approaches.