Endoscopic Ultrasound-Directed Transgastric ERCP in Patients With Roux-En-Y Gastric Bypass: A Multicenter Prospective...

Area of Science:

• Gastroenterology
• Endoscopy
• Bariatric Surgery

Background:

• Roux-en-Y gastric bypass (RYGB) surgery presents challenges for endoscopic retrograde cholangiopancreatography (ERCP).
• Endoscopic ultrasound-directed ERCP (EDGE) utilizes a lumen-apposing metal stent (LAMS) to create a gastro-gastrostomy, facilitating ERCP in RYGB patients.
• Prospective data on the efficacy and safety of the EDGE technique are limited.

Purpose of the Study:

• To prospectively evaluate the efficacy and safety of the two-step EDGE technique in patients who have undergone RYGB.
• To assess the technical success rate of EDGE, including LAMS placement and subsequent ERCP.
• To determine the fistula closure rate and identify any adverse events associated with the procedure.

Main Methods:

• A multicenter prospective cohort study involving patients scheduled for elective ERCP post-RYGB.
• The EDGE procedure was performed in two distinct steps.
• Primary endpoint was overall technical success; secondary endpoints included LAMS placement success, ERCP success, fistula persistence, and adverse events.

Main Results:

• Overall technical success was high at 96.2% (25/26 patients).
• No persistent fistulas were observed in the remaining 24 patients post-procedure.
• Adverse events occurred in 15.4% of patients (4/26), with 7.7% (2/26) directly related to EDGE.

Conclusions:

• The two-step EDGE technique demonstrates high technical success and is effective in achieving fistula closure in RYGB patients.
• While relatively safe, the procedure is associated with a notable rate of adverse events, requiring careful consideration.
• Further research may be warranted to optimize safety and minimize complications associated with EDGE in this complex patient population.