Comparing EUS-directed Transgastric ERCP (EDGE) Versus Laparoscopic-Assisted ERCP Versus Enteroscopic ERCP: A Network...

Area of Science:

• Gastroenterology
• Surgical Innovation
• Medical Technology Assessment

Background:

• Management of choledocholithiasis presents unique challenges in patients who have undergone Roux-en-Y gastric bypass (RYGB).
• Existing endoscopic and surgical techniques require careful evaluation for efficacy and safety in this specific patient population.

Purpose of the Study:

• To compare the technical success rates, adverse events, and procedural durations of three distinct approaches for managing choledocholithiasis in RYGB patients.
• To identify the optimal procedural approach based on comparative effectiveness and efficiency.

Main Methods:

• A systematic literature search was conducted across five databases to identify relevant studies.
• Direct and network meta-analyses were performed using a random effects model to compare endoscopic ultrasound-directed transgastric ERCP (EDGE), enteroscopy-assisted ERCP (E-ERCP), and laparoscopic-assisted ERCP (LA-ERCP).
• A significance threshold of P < 0.05 was applied for all analyses.

Main Results:

• EDGE and LA-ERCP demonstrated significantly higher technical success rates compared to E-ERCP.
• No statistically significant differences in adverse event rates were observed among the three approaches (EDGE, E-ERCP, LA-ERCP).
• EDGE exhibited the shortest procedural duration, followed by E-ERCP, and then LA-ERCP, with EDGE showing a significant time advantage over both.

Conclusions:

• EDGE and LA-ERCP are superior to E-ERCP in terms of technical success for choledocholithiasis management in RYGB patients.
• The choice between EDGE and LA-ERCP may be influenced by procedural time, with EDGE being significantly faster.
• EDGE is recommended as a preferred first-line procedure due to its high success rate and shorter procedural duration.