Endoscopic Retrograde Cholangiopancreatography in Patients With Roux-en-Y Gastric Bypass

Endoscopic ultrasound-directed transgastric ERCP (EDGE): a systematic review describing the outcomes, adverse events, and knowledge gaps

“…Endoscopic Retrograde Cholangiopancreatography (ERCP) is challenging in patients with rouxen-y gastric bypass (RYGB) due to their altered anatomy. The limitations of currently available techniques for performing pancreaticobiliary interventions in this population has led to the emergence of endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) as a viable, completely endoscopic alternative that has been adopted by many ERCP providers in academic medical centers [1][2][3].…”

“…ERCP can subsequently be performed through the LAMS. The main advantage and likely appeal to many endoscopists is that EDGE is a completely endoscopic technique that allows the endoscopist to perform ERCP using a traditional duodenoscope and standard accessories [1,2]. Case series have shown this procedure in expert hands has a high rate of technical and clinical success, with adverse event rates at low levels [4,5].…”

ERCP in patients with Roux-en-Y gastric bypass: is there a one-procedure-fits-all approach?

“…Otherwise, BEA-ERCP can be a first-line approach in specialized centers that have high procedural success rates. This approach can avoid surgery, the creation of fistulas, and has a more favorable adverse event profile compared with other approaches [3].…”

“…The main advantage is that it does not require a surgical procedure or creation of a gastrostomy/fistu-la. In addition, the adverse event profile is favorable compared with the other options [3]. However, it can be a technically difficult procedure owing to adhesions from prior surgery, sharp anastomotic angles to traverse, and the tangential views of the papilla given by the forward-viewing scope causing difficulty during cannulation.…”

“…Moreover, the smaller diameter channel and lack of elevator do not allow for standard ERCP equipment to be used or deployed in the usual fashion. Procedure success rates have been reported to be as high as 91 % in very high volume expert centers [4], but most studies have shown procedural success rates closer to 70 % in tertiary centers [3,5].…”