Endoscopic Ultrasound-Directed Transgastric ERCP Research Articles

Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE): a Single-Center US Experience with Follow-up Data on Fistula Closure

Endoscopic ultrasound-directed transgastric ERCP (EDGE) by creating an anastomosis from the gastric pouch or jejunum to the excluded stomach allows performance of ERCP in Roux-en-Y gastric bypass (RYGB) anatomy. Concern for persistent fistula following stent removal and sparse data limit adoption. Retrospective review of consecutive patients undergoing EDGE over a 2-year period. Nineteen RYGB patients underwent EDGE; three had previously failed ERCP by the device-assisted method. Indications for ERCP were choledocholithiasis (8), recurrent acute pancreatitis (6), benign post-surgical stricture (3), elevated bilirubin, and papillary stenosis (1 each). EDGE was technically successful in all 19 patients with jejunogastric anastomosis in 11 patients and gastrogastric in 8 using a 15-mm lumen-apposing metal stent. Stent malposition occurred in six and was managed by rescue maneuvers. ERCP was performed in the same session in four patients; the remainder were delayed after a mean of 48days. Diagnostic endoscopic ultrasound (EUS) was performed in four patients. No severe adverse events occurred; clinical success was 100%. Stents were removed after a mean dwell time of 182days. Argon plasma coagulation (APC) was used to promote fistula closure in 12 patients. Upper GI series to assess fistula closure was obtained in 11 patients after a mean of 182days following stent removal. One persistent fistula was identified and closed endoscopically. EDGE is an effective modality for performing ERCP in patients with RYGB anatomy and can be performed via gastrogastric or jejunogastric approaches. Persistent fistula is uncommon and can be managed endoscopically. APC may promote fistula closure.

Treatment of Biliary Stent Complications in a Patient With Roux-En-Y Gastric Bypass Using Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE): A Case Report

Treatment of Biliary Stent Complications in a Patient With Roux-En-Y Gastric Bypass Using Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE): A Case Report

Treatment of Large CBD Stones Using Endoscopic Ultrasound (EUS)-Directed Transgastric ERCP (EDGE) in Patients With Roux-en-Y Gastric Bypass

Treatment of Large CBD Stones Using Endoscopic Ultrasound (EUS)-Directed Transgastric ERCP (EDGE) in Patients With Roux-en-Y Gastric Bypass