Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(04): E459-E467
DOI: 10.1055/a-1783-9564
Original article

Comparison of endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography outcomes using various technical approaches

Firas Bahdi
1   Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
,
Rollin George
2   Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, United States
,
Kavea Paneerselvam
1   Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
,
Dang Nguyen
3   Texas Digestive Disease Consultants, Houston, Texas, United States
,
Wasif M. Abidi
2   Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, United States
4   Baylor St Luke’s Medical Center, Houston, Texas, United States
,
Mohamed O. Othman
2   Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, United States
4   Baylor St Luke’s Medical Center, Houston, Texas, United States
,
Isaac Raijman
2   Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, United States
3   Texas Digestive Disease Consultants, Houston, Texas, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Roux-en-Y gastric bypass presents an anatomic challenge for patients needing ERCP. EUS-directed transgastric ERCP (EDGE) offers high clinical success but carries considerable risk of adverse events (AEs) with no standardized technical approach. In our study, we review the safety and efficacy of our various EDGE technical approaches.

Patients and methods A retrospective single-center study of all patients who underwent EDGE procedures between February 2018 and November 2019. Primary outcomes included comparing the technical and clinical success, AEs, and lumen-apposing metal stent (LAMS) migration rates per access route (gastrogastric vs jejuno-gastric), number of procedure stages (single-stage vs two-stage), and stent size (15 mm vs 20 mm). Secondary outcomes included LAMS migration characteristics and management.

Results Thirty-two EDGE procedures were performed in 29 patients, including 17 single-stage and 15 two-stage procedures, 23 gastrogastric, and nine jejuno-gastric routes, fourteen 15-mm and 17 20-mm LAMS. Overall technical and clinical success rates were 96.9 % and 87.1 %, respectively, without any significant difference between groups. The overall AE rate was (34.4 %) and was significantly lower in the 20-mm LAMS group compared to the 15-mm group (17.6 % vs 57.1 %, P = 0.03). Compared to two-stage procedures, there was no significant difference in AEs with single-stage procedures (35.3 % vs 33.3 %, P = 0.33). The LAMS migration rate was (25 %) with no significant difference between groups. Most migrations were around the index procedure and managed endoscopically (62.5 %).

Conclusions EDGE offers high clinical success rates but AE rates remain significant. In our series, a 20-mm LAMS resulted in a significantly lower AE rate than the 15-mm LAMS. Large multicenter studies are recommended to identify technical factors leading to an optimal EDGE procedure.



Publication History

Received: 22 July 2021

Accepted after revision: 26 November 2021

Article published online:
14 April 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • 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
    CrossrefPubMedGoogle Scholar
  • 2 Angrisani L, Santonicola A, Iovino P. et al. IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. Obes Surg 2018; 28: 3783-3794
    CrossrefPubMedGoogle Scholar
  • 3 Wang TJ, Ryou M. Evolving techniques for endoscopic retrograde cholangiopancreatography in gastric bypass patients. Curr Opin Gastroenterol 2018; 34: 444-450
    CrossrefPubMedGoogle Scholar
  • 4 Dhindsa BS, Dhaliwal A, Mohan BP. et al. EDGE in Roux-en-Y gastric bypass: How does it compare to laparoscopy-assisted and balloon enteroscopy ERCP: a systematic review and meta-analysis. Endosc Int Open 2020; 8: E163-E171
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 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 Gastroentero 2019; 53: 304-308
    CrossrefPubMedGoogle Scholar
  • 6 Abbas AM, Strong AT, Diehl DL. et al. LA-ERCP Research Group. Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass. Gastrointest Endosc 2018; 87: 1031-1039
    CrossrefPubMedGoogle Scholar
  • 7 da Ponte-Neto AM, Bernardo WM, de A Coutinho LM. 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
    CrossrefPubMedGoogle Scholar
  • 8 Kedia P, Tyberg A, Kumta NA. et al. EUS-directed transgastric ERCP for Roux-en-Y gastric bypass anatomy: a minimally invasive approach. Gastrointest Endosc 2015; 82: 560-565
    CrossrefPubMedGoogle Scholar
  • 9 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
    CrossrefPubMedGoogle Scholar
  • 10 Krafft MR, Hsueh W, James TW. et al. The EDGI new take on EDGE: EUS-directed transgastric intervention (EDGI), other than ERCP, for Roux-en-Y gastric bypass anatomy: a multicenter study. Endosc Int Open 2019; 7: E1231-E1240
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Tyberg A, Kedia P, Tawadros A. et al. EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE): the first learning curve. J Clin Gastroenterol 2020; 54: 569-572
    CrossrefPubMedGoogle Scholar
  • 12 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
    CrossrefPubMedGoogle Scholar
  • 13 Ma IT, Madura 2nd JA. Gastrointestinal complications after bariatric surgery. Gastroenterol Hepatol 2015; 11: 526-535
    PubMedGoogle Scholar
  • 14 Shiffman ML, Sugerman HJ, Kellum JM. et al. Gallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment of morbid obesity. Am J Gastroenterol 1991; 86: 1000-1005
    PubMedGoogle Scholar
  • 15 Prakash S, Elmunzer BJ, Forster EM. et al. EUS-directed transgastric ERCP: systematic review to describe outcomes, adverse events and knowledge gaps. Endoscopy 2021; DOI: 10.1055/a-1376-2394.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 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
    CrossrefPubMedGoogle Scholar
  • 17 Shinn B, Boortalary T, Raijman I. et al. Maximizing success in single-session EUS-directed transgastric ERCP: a retrospective cohort study to identify predictive factors of stent migration. Gastrointest Endosc 2021; 94: 727-732 S0016-5107(21)01320-1
    CrossrefPubMedGoogle Scholar