EUS-directed transgastric endoscopic retrograde cholangiopancreatography versus laparoscopic-assisted ERCP versus deep enteroscopy-assisted ERCP for patients with RYGB

Abstract

Background and study aims Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) is a novel technique for managing pancreaticobiliary diseases in patients with a history of Roux-en-Y Gastric Bypass (RYGB). It has shown to have high technical success rates and fewer adverse events as compared to laparoscopic-assisted ERCP (LA-ERCP). We compared the technical success and clinical outcomes of EDGE vs. LA-ERCP vs. E-ERCP. Patients and methods A retrospective chart review was performed for 56 patients, of whom 18 underwent LA-ERCP, 12 underwent E-ERCP, and 26 had EDGE, and a comparison of technical success and complication rates was done. Results Baseline demographic characteristics of patients undergoing these procedures, including age and gender, were comparable. The technical success rate for patients in the EDGE group were 100 % (n = 26), compared with 94 % (n = 17) and 75 % (n = 9) in the LA-ERCP and E-ERCP groups (P = 0.02). In the EDGE group, 8 % of patients (n = 2) had bleeding, and 4 % of patients (n = 1) had lumen-apposing metal stent migration occur during the procedure. In the LA-ERCP group 6 % (n = 1) of patient had bleeding, 6 % (n = 1) post-ERCP pancreatitis and 6 % (n = 1) were diagnosed with an intra-abdominal infection post-procedure. Time to complete the EDGE procedure was significantly shorter at 79 ± 31 mins, compared with 158 ± 50 mins for LA-ERCP and 102 ± 43 mins for E-ERCP (P < 0.001). Conclusion EDGE is a novel procedure with short procedure times and an effective alternative to LA-ERCP and E-ERCP in management of pancreaticobiliary diseases in patients with a history of RYGB.

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

“…A detailed report of the abstract review and full text review is described in Figure 2. The included studies were retrospective cohort studies (n=9) and case reports (n=8) [ Figure 2] [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] .…”

“…A total of 2143 abstracts were identified from the initial search of the three databases during the target time period, with 17 articles selected for the final study [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. A detailed report of the abstract and full-text reviews is shown in ▶ Fig.…”

“…Mendoza et al [22] 2018 Choledocholithiasis de Benito Sanz et al [14] 2020 Single Center Simons-Linares et al [23] 2019 Biliary stricture repair, complicated by stent migration Kochhar et al [15] 2020 Single Center. Compared to l-ERCP and e-ERCP…”

Endoscopic retrograde cholangiopancreatography: Current practice and future research

“…A retrospective multicenter review[ 47 ] of 178 patients reported a technical success of 98% (175/178) countered by 4 severe adverse events (SAE) (2.2%) and 10% of patients having a documented persistent fistula (9/90). It has been proposed that the EDGE could be used in patients with a RYGB, of which the details like limb length are unknown, and in patients with a surgically absent gallbladder[ 48 ]. A meta-analysis showed comparable rates of success to the laparoscopic assisted ERCP[ 45 ].…”

ERCP in RYGB-patients: One size fits all?

“…The series by Kochar et al in this edition of EIO [5] is a welcome addition to the existing literature. They present a 56-patient, single-center, 4-year retrospective experience with all three methods, with 26, 18, and 12 patients handled by EDGE, LA-ERCP, and E-ERCP, respectively.…”