EDGE in Roux-en-Y gastric bypass: How does it compare to laparoscopy-assisted and balloon enteroscopy ERCP: a systematic review and meta-analysis

Banreet Singh Dhindsa; Amaninder Dhaliwal; Babu P. Mohan; Harmeet Singh Mashiana; Mohit Girotra; Shailender Singh; Gordon Ohning; Ishfaq Bhat; Douglas G. Adler

doi:10.1055/a-1067-4411

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(02): E163-E171
DOI: 10.1055/a-1067-4411

Original article

EDGE in Roux-en-Y gastric bypass: How does it compare to laparoscopy-assisted and balloon enteroscopy ERCP: a systematic review and meta-analysis

Authors

Banreet Singh Dhindsa

¹University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, United States
Amaninder Dhaliwal

²Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
Babu P. Mohan

³Banner University Medical Center, University of Arizona, Tucson, Arizona, United States
Harmeet Singh Mashiana

²Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
Mohit Girotra

⁴Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, Florida, United States
Shailender Singh

²Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
Gordon Ohning

⁵Division of Gastroenterology, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, United States
Ishfaq Bhat

²Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
Douglas G. Adler

⁶Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah

Abstract

Background and study aims Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a new endoscopic procedure to perform ERCP in Roux-en-y gastric bypass (RYGB) patients. The aim of this study was to conduct a systematic review and meta-analysis to evaluate technical success, clinical success and adverse effects of EDGE and compare it to laparoscopic ERCP (LA-ERCP) and balloon ERCP (BE-ERCP).

Patients and methods We conducted a comprehensive search of several databases and conference proceedings including PubMed, EMBASE, Google-Scholar, LILACS, SCOPUS, and Web of Science databases to identify studies reporting on EDGE, LA-ERCP, and BE-ERCP. The primary outcome was to evaluate technical and clinical success of all three procedures and the secondary analysis focused on calculating the pooled rate of all adverse events (AEs), along with the commonly reported AE subtypes.

Results Twenty-four studies on 1268 patients were included in our analysis with the majority of the population being males with mean age 53.72 years. Pooled rates of technical and clinical success with EDGE wer 95.5 % and 95.9 %, with LA-ERCP were 95.3 % and 92.9 % and were BE-ERCP were 71.4 % and 58.7 %, respectively. Pooled rates of all AEs with EDGE were 21.9 %, with LA-ERCP 17.4 % and with BE-ERCP 8.4 %. Stent migration was the most common AE with EDGE with 13.3 % followed by bleeding with 6.6 %.

Conclusion Our meta-analysis demonstrated that the technical and clinical success of EDGE procedure is better than BE-ERCP and comparable to that of LA-ERCP in RYGB patients. EDGE also has a similar safety profile as compared to LA-ERCP but has higher AE rate as compared to BE-ERCP.

Full Text

References

References
1 Ogden CL, Carroll MD, Kit BK. et al. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 2014; 311: 806-814
2 Mechanick JI, Youdim A, Jones DB. et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient -- 2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity 2013; 21 (Suppl. 01) S1-27
3 Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg 2013; 23: 427-436
4 Angrisani L, Santonicola A, Iovino P. et al. IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. Obes Surg 2018; 28: 3783-3794
5 Byrne TK. Complications of surgery for obesity. Surg Clin North Am 2001; 81: 1181-1193, vii-viii
6 Villegas L, Schneider B, Provost D. et al. Is routine cholecystectomy required during laparoscopic gastric bypass?. Obes Surg 2004; 14: 206-211
7 Calle EE, Rodriguez C, Walker-Thurmond K. et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003; 348: 1625-1638
8 Wang TJ, Ryou M. Evolving techniques for endoscopic retrograde cholangiopancreatography in gastric bypass patients. Curr Opin Gastroenterol 2018; 34: 444-450
9 Ross AS. Techniques for performing ERCP in Roux-en-Y gastric bypass patients. Gastroenterol Hepatol (NY) 2012; 8: 390-392
10 da Ponte-Neto AM, Bernardo WM, de Coutinho ALM. et al. Comparison between enteroscopy-based and laparoscopy-assisted ERCP for accessing the biliary tree in patients with roux-en-y gastric bypass: systematic review and meta-analysis. Obes Surg 2018; 28: 4064-4076
11 Abbas AM, Strong AT, Diehl DL. et al. Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass. Gastrointest Endosc 2018; 87: 1031-1039
12 Banerjee N, Parepally M, Byrne TK. et al. Systematic review of transgastric ERCP in Roux-en-Y gastric bypass patients. Surg Obes Relat Dis 2017; 13: 1236-1242
13 Kedia P, Sharaiha RZ, Kumta NA. et al. Internal EUS-directed transgastric ERCP (EDGE): game over. Gastroenterology 2014; 147: 566-568
14 Bukhari M, Kowalski T, Nieto J. et al. An international, multicenter, comparative trial of EUS-guided gastrogastrostomy-assisted ERCP versus enteroscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Gastrointest Endosc 2018; 88: 486-494
15 Chiang AL, Gaidhane M, Loren DE. et al. 338 Impact of EUS-directed transgastric ercp (edge procedure) access route on technical success and adverse events: a multi-center experience. Gastrointest Endosc 2018; 87: AB70-AB71
16 James TW, Baron TH. Endoscopic ultrasound-directed transgastric ERCP (EDGE): a single-center us experience with follow-up data on fistula closure. Obes Surg 2019; 29: 451-456
17 Wang TJ, Thompson CC, Ryou M. Gastric access temporary for endoscopy (GATE): a proposed algorithm for EUS-directed transgastric ERCP in gastric bypass patients. Surg Endosc 2019; 33: 2024-2033
18 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151: 264-269
19 Stroup DF, Berlin JA, Morton SC. et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283: 2008-2012
20 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603-605
21 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
22 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
23 Sutton AJ, Abrams KR, Jones DR. et al. Methods for meta-analysis in medical research. Wiley Chichester; 2000
24 Higgins JPT, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
25 Kanwal F, White D. Systematic reviews and meta-analyses in clinical gastroenterology and hepatology. Clin Gastroenterol Hepat 2012; 10: 1184-1186
26 Guyatt GH, Oxman AD, Kunz R. et al. GRADE guidelines: 7. Rating the quality of evidence–inconsistency. J Clin Epidem 2011; 64: 1294-1302
27 Easterbrook PJ, Gopalan R, Berlin JA. et al. Publication bias in clinical research. Lancet 1991; 337: 867-872
28 Duval S, Tweedie R. Trim and fill: a simple funnel‐plot–based method of testing and adjusting for publication bias in meta‐analysis. Biometrics 2000; 56: 455-463
29 Rothstein HR, Sutton AJ, Borenstein M. Publication bias in meta-analysis: Prevention, Assessment and Adjustments. Wiley; 2005
30 Irani S, Yang J, Khashab MA. Mitigating lumen-apposing metal stent dislodgment and allowing safe, single-stage EUS-directed transgastric ERCP. VideoGIE 2018; 3: 322-324
31 Kedia P, Kumta NA, Sharaiha R. et al. Bypassing the bypass: EUS-directed transgastric ERCP for Roux-en-Y anatomy. Gastrointest Endosc 2015; 81: 223-224
32 Tyberg A, Nieto J, Salgado S. et al. Endoscopic ultrasound (EUS)-directed transgastric endoscopic retrograde cholangiopancreatography or EUS: mid-term analysis of an emerging procedure. Clin Endosc 2017; 50: 185-190
33 Kedia P, Tarnasky PR, Nieto J. et al. EUS-directed transgastric ERCP (EDGE) versus laparoscopy-assisted ERCP (LA-ERCP) for Roux-en-Y gastric bypass (RYGB) anatomy: a multicenter early comparative experience of clinical outcomes. J Clin Gastroenterol 2019; 53: 304-308
34 Ngamruengphong S, Nieto J, Kunda R. et al. Endoscopic ultrasound-guided creation of a transgastric fistula for the management of hepatobiliary disease in patients with Roux-en-Y gastric bypass. Endoscopy 2017; 49: 549-552
35 Bukhari M, Kowalski T, Nieto J. et al. An international, multicenter, comparative trial of EUS-guided gastrogastrostomy-assisted ERCP versus enteroscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Gastrointest Endosc 2018; 88: 486-494
36 Bertin PM, Singh K, Arregui ME. Laparoscopic transgastric endoscopic retrograde cholangiopancreatography (ERCP) after gastric bypass: case series and a description of technique. Surg Endosc 2011; 25: 2592-2596
37 Bowman E, Greenberg J, Garren M. et al. Laparoscopic-assisted ERCP and EUS in patients with prior Roux-en-Y gastric bypass surgery: a dual-center case series experience. Surg Endosc 2016; 30: 4647-4652
38 May DD, Parker DM, Vogels ED. et al. Outcomes of laparoscopic-assisted ERCP after Roux-En-Y gastric bypass: safe and effective for management of sphincter of Oddi dysfunction. Endosc Int Open 2019; 7: E1276-E1280
39 Falcao M, Campos JM, Galvao Neto M. et al. Transgastric endoscopic retrograde cholangiopancreatography for the management of biliary tract disease after Roux-en-Y gastric bypass treatment for obesity. Obes Surg 2012; 22: 872-876
40 Farukhi MCB, Davis B. et al. Treatment of biliary disease with transgastric ERCP after Roux-En-Y gastric bypass. Surg Endosc 2016; S325-500
41 Frederiksen NA, Tveskov L, Helgstrand F. et al. Treatment of common bile duct stones in gastric bypass patients with laparoscopic transgastric endoscopic retrograde cholangiopancreatography. Obes Surg 2017; 27: 1409-1413
42 Grimes KL, Maciel VH, Mata W. et al. Complications of laparoscopic transgastric ERCP in patients with Roux-en-Y gastric bypass. Surg Endosc 2015; 29: 1753-1759
43 Habenicht Yancey K, McCormack LK, McNatt SS. et al. Laparoscopic-assisted transgastric ERCP: a single-institution experience. J Obes 2018; 2018: 8275965
44 Kumar U, Kroner PT, Jovanovic I. et al. Balloon-overtube enteroscopy assisted (BAE) versus laparoscopy-assisted ERCP in Bariatric Post-Roux-en-Y gastric bypass patients: a comparative study. Gastrointest Endosc 2016; 83: AB298
45 Lin C, Aragon RJ, Carr AD. et al. Direct access ERCP: a novel and reliable surgical technique for patients with Roux-en-Y anatomy. Surg Endosc 2014; 28: 311
46 Mejia R, Achurra P, Gabrielli M. et al. Laparoscopy-assisted trans-gastric rendez-vous for the treatment of common bile duct stones in patients with prior Roux-en-Y gastric bypass. Obes Surg 2016; 26: 2809-2813
47 Paranandi B, Joshi D, Mohammadi B. et al. Laparoscopy-assisted ERCP (LA-ERCP) following bariatric gastric bypass surgery: initial experience of a single UK centre. Frontline Gastroenterol 2016; 7: 54-59
48 Saleem A, Levy MJ, Petersen BT. et al. Laparoscopic assisted ERCP in Roux-en-Y gastric bypass (RYGB) surgery patients. J Gastrointest Surg 2012; 16: 203-208
49 Schreiner MA, Chang L, Gluck M. et al. Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP in bariatric post-Roux-en-Y gastric bypass patients. Gastrointest Endosc 2012; 75: 748-756
50 Snauwaert C, Laukens P, Dillemans B. et al. Laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography in bariatric Roux-en-Y gastric bypass patients. Endosc Int Open 2015; 3: E458-E463
51 Sun Z, Rodriguez J, Albeldawi M. et al. Laparoscopic transgastric endoscopic retrograde cholangiopancreatography for the treatment of biliary tract disease after Roux-en-Y gastric bypass. J Am Coll Surg 2014; 219: e60-e61
52 Choi EK, Chiorean MV, Cote GA. et al. ERCP via gastrostomy vs. double balloon enteroscopy in patients with prior bariatric Roux-en-Y gastric bypass surgery. Surg Endosc 2013; 27: 2894-2899
53 Kashani A, Abboud G, Lo SK. et al. Double balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in Roux-en-Y gastric bypass anatomy: expert vs. novice experience. Endosc Int Open 2018; 6: E885-E891
54 Mohan BP, Adler DG. Heterogeneity in systematic review and meta-analysis: how to read between the numbers. Gastrointest Endosc 2019; 89: 902-903

Supplementary Material

Supplementary material (PDF)