Efficacy &amp; safety of EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) in Roux-en-Y gastric bypass anatomy: a systematic review &amp; meta-analysis

Deliwala, Smit; Mohan, Babu P.; Yarra, Pradeep; Khan, Shahab R.; Chandan, Saurabh; Ramai, Daryl; Kassab, Lena L.; Facciorusso, Antonio; Dhawan, Manish; Adler, Douglas G.; Kaul, Vivek; Chawla, Saurabh; Kochhar, Gursimran

doi:10.1007/s00464-023-09926-7

Cited by 16 publications

(9 citation statements)

References 48 publications

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“…In a large multicenter study that included a total of 178 patients, technical success was achieved in 98% of the cases with severe adverse events requiring surgical intervention encountered in only 2.2% of cases [26]. A recent meta-analysis that comprised 16 studies and a total of 470 patients who underwent EDGE for the management of PB pathologies showed a pooled technical and clinical success rate of 96% and 91%, respectively [27 ▪ ]. In a multicenter study in which EDGE was compared to e-ERCP, the technical success was significantly higher in the EDGE group compared to the e-ERCP group (100% vs. 60%, P < 0.001), with a significantly shorter procedure time (49.8 min vs. 90.7 min, P < 0.001) [28].…”

Section: Pancreaticobiliary Interventionsmentioning

confidence: 99%

“…It is usually recommended to remove the LAMS only when no additional biliopancreatic interventions are anticipated. Once the LAMS is removed a fistula may remain patent, leading potentially to weigh regain in patients with history of bariatric surgery [27 ▪ ,32]. It is currently debated whether the resulting fistula should be closed immediately following LAMS removal or be allowed to close spontaneously, as well as whether routine radiologic control should be performed in the weeks following LAMS removal to check for fistula persistence.…”

Section: Optimizing the Techniques: Evidence Behind Different Technic...mentioning

confidence: 99%

“…Practices are diverse and at present, given the lack of specific guidelines, depend on the preference of the endoscopist and local availability of closure devices. Some methods of fistula closure include the use of argon plasma coagulation (APC) after stent removal with or without the addition of endoscopic suturing or the use of over-the-scope clips (OTSC) [27 ▪ ] (Fig. 3).…”

Section: Optimizing the Techniques: Evidence Behind Different Technic...mentioning

confidence: 99%

“…The transluminal deployment of LAMS during procedures such as EDGE, EDEE, and EDGI are considered generally safe if performed by therapeutic endoscopists in a high-volume center [7]. However, complications may happen in 5.6–17% of cases [27 ▪ ,33,36 ▪ ]. Stent misdeployment is considered one of the most severe complications, and it happens in 8% of cases [27 ▪ ].…”

Section: Adverse Events and Time For Lumen Apposing Metal Stents Removalmentioning

confidence: 99%

“…However, complications may happen in 5.6–17% of cases [27 ▪ ,33,36 ▪ ]. Stent misdeployment is considered one of the most severe complications, and it happens in 8% of cases [27 ▪ ]. Recently, a classification of stent misdeployment has been developed for EUS-guided gastroenterostomy (EUS-GE) [45 ▪▪ ].…”

Section: Adverse Events and Time For Lumen Apposing Metal Stents Removalmentioning

confidence: 99%

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Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy

Ichkhanian,

Jovani

2023

Current Opinion in Gastroenterology

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Purpose of review Lumen apposing metal stents (LAMS) have been increasingly used to manage patients with surgically altered anatomy (SAA), who would have otherwise required percutaneous or surgical interventions. Via the creation of de-novo anastomoses, LAMS provides a conduit to access distal parts of the gastrointestinal tract to perform various interventions. Recent findings Pancreatobiliary (PB) and non-PB interventions are challenging in patients with SAA. Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) and endoscopic ultrasound (EUS)-directed transenteric ERCP (EDEE) are effective procedures that are being increasingly utilized to perform ERCP in patient with Roux-en-Y gastric bypass (RYGB) and non-RYGB SAA, respectively. Furthermore, EUS-directed trans-gastric intervention (EDGI) is a collective term for the non-PB procedures that could be performed in patients with SAA. EDGE/EDEE/EDGI are considered relatively safe procedures, however, intra-procedural stent misdeployement, and long-term ramifications of persistent fistula and stent migration could require endoscopic or, in rare instances, surgical management. Summary The advent of LAMS has revolutionized the therapeutic capabilities of EUS, by allowing the creation of new gastrointestinal anastomoses. With the growing body of literature, it is expected that such techniques will be more commonly performed in the community, providing less invasive and more effective treatment options for patients with SAA.

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Section: Pancreaticobiliary Interventionsmentioning

confidence: 99%

Section: Optimizing the Techniques: Evidence Behind Different Technic...mentioning

confidence: 99%

Section: Optimizing the Techniques: Evidence Behind Different Technic...mentioning

confidence: 99%

Section: Adverse Events and Time For Lumen Apposing Metal Stents Removalmentioning

confidence: 99%

Section: Adverse Events and Time For Lumen Apposing Metal Stents Removalmentioning

confidence: 99%

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Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy

Ichkhanian,

Jovani

2023

Current Opinion in Gastroenterology

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Effectiveness and complication rates of percutaneous transhepatic fluoroscopy-guided management of common bile duct stones: a single-arm meta-analysis

et al. 2023

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Biliary drainage in patients with malignant distal biliary obstruction: results of an Italian consensus conference

Marzioni,

Crinò,

Lisotti

et al. 2024

Surg Endosc

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Background Malignant Distal Biliary Obstruction (MBDO) is a common event occurring along the natural history of both pancreatic cancer and cholangiocarcinoma. Epidemiological and biological features make MBDO one of the key elements of the clinical management of patients suffering for of pancreatic cancer or cholangiocarcinoma. The development of dedicated biliary lumen-apposing metal stents (LAMS) is changing the clinical work up of patients with MBDO. i-EUS is an Italian network of clinicians and scientists with a special interest in biliopancreatic endoscopy, EUS in particular. Methods The scientific methodology was chosen in line with international guidance and in a fashion similar to those applied by broader scientific associations. PICO questions were elaborated and subsequently voted by a broad panel of experts within a simplified Delphi process. Results and conclusions The manuscripts describes the results of a consensus conference organized by i-EUS with the aim of providing an evidence based-guidance for the appropriate use of the techniques in patients with MBDO.

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Efficacy & safety of EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) in Roux-en-Y gastric bypass anatomy: a systematic review & meta-analysis

Cited by 16 publications

References 48 publications

Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy

Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy

Effectiveness and complication rates of percutaneous transhepatic fluoroscopy-guided management of common bile duct stones: a single-arm meta-analysis

Biliary drainage in patients with malignant distal biliary obstruction: results of an Italian consensus conference

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