EUS-directed transgastric interventions in Roux-en-Y gastric bypass anatomy: a multicenter experience

Ghandour, Bachir; Shinn, Brianna; Dawod, Qais M.; Fansa, Sima; Chafic, Abdul Hamid El; Irani, Shayan; Pawa, Rishi; Gutta, Aditya; Ichkhanian, Yervant; Paranandi, Bharat; Pawa, Swati; Al‐Haddad, Mohammad; Zuchelli, Tobias; Huggett, Matthew T.; Bejjani, Michael; Sharaiha, Reem Z.; Kowalski, Thomas E.; Khashab, Mouen A.; Zhang, Linda; Loren, David E.; Kumar, Anand; Chiang, Austin L.; Schlachterman, Alexander; Saab, Omar; Blake, Benjamin; Obri, Mark S.; Keane, Margaret G.; Mony, Shruti

doi:10.1016/j.gie.2022.05.008

Cited by 27 publications

(30 citation statements)

References 29 publications

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“…Although less frequently encountered, non-PB procedures are equally challenging in patients with SAA. EUS-directed trans-gastric intervention (EDGI) is a collective term used to describe these non-ERCP procedures in patients with SAA which entails access the excluded stomach or the jejunal limb via the creation of de-novo anastomoses using LAMS to perform a wide range of therapeutic and diagnostic procedures [34,35,36 ▪ ].…”

Section: Non-pancreatobiliary Interventionsmentioning

confidence: 99%

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: Non-pancreatobiliary Interventionsmentioning

confidence: 99%

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

Ichkhanian,

Jovani

2023

Current Opinion in Gastroenterology

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“…This technique is more focused on applying in patients who receive endoscopic retrograde cholangiopancreatography (ERCP) treatments with post-surgery anatomical changes like Roux-en-Y gastric bypass. Technical success rates can achieve 96% and persistent fistulas may occur in 11.7% patients, but endoscopic closure seems to be effective ( 36 ).…”

Section: Indications and Outcomes Of Ec-lamsmentioning

confidence: 99%

Current uses of electro-cautery lumen apposing metal stents in endoscopic ultrasound guided interventions

Liu

et al. 2022

Front. Med.

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The electro-cautery lumen apposing metal stent (EC-LAMS) is a newly developed device that integrates the electro-cautery cyctotome with the one-step metal stent delivery and releasing system in recent years. LAMS was first designed to complete the drainage of pancreatic fluid collection under endoscopic ultrasound guidance, and the technological innovation of EC-LAMS has made more off-labeled indications of endoscopic intervention for gastrointestinal diseases realized, such as abdominal fluid drainage, bile duct, or gallbladder drainage through stomach or duodenum, gastrointestinal anastomosis, and the establishment of fistulous channel for further endoscopic operation when necessary. The unique feature of this metal stent is that it has the design of a saddle shape and a large lumen, and can almost connect the adjacent structures to minimize the risk of perforation and leakage. Compared with traditional LAMS, EC-LAMS, an advanced integrated device, can greatly simplify the endoscopic process, shorten the procedure time and reduce the technical difficulty, thus it can help endoscopists complete more complex endoscopic interventions. In this review, we discuss the state of art with regard to EC-LAMS and its endoscopic process, current indications, outcomes, adverse events, and future application prospects.

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“…In a more recent case-control study, Ghandour and colleagues matched 25 patients with a persistent GG fistula with 50 patients with no evidence of a fistula. Similarly, no patient or procedural characteristics were predictive of fistula persistence except for LAMS dwell time (127 days in cases vs. 48 days in controls, P = 0.02), with incidence of a persistent GG fistula increasing by 9.5 % for every 7 days the LAMS was left in situ [1]. Patients with persistent GG fistulas gained significantly more weight than those without (> 5 % total body weight gain; 33.3 % v. 10.3 %, P = 0.03).…”

mentioning

confidence: 93%

“…Endoscopic ultrasound-directed transgastric ERCP (EDGE), in comparison, is a completely endoscopic procedure that uses a lumen-apposing metal stent (LAMS) to create a gastrogastric (GG) or jejunogastric fistula, bridging the gastric pouch with the excluded stomach and, thus, allowing for more conventional ERCP. Since its first description in 2015, published data on EDGE have demonstrated excellent technical and clinical success rates (91-100 %) [1][2][3]; however, data on long-term outcomes, in particular regarding the incidence and metabolic consequences of persistent GG fistulas, have been limited.…”

mentioning

confidence: 99%

Living on the EDGE: Preparing for long-term success following EDGE procedure

Hanscom

Law

2023

Endosc Int Open

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EUS-directed transgastric interventions in Roux-en-Y gastric bypass anatomy: a multicenter experience

Cited by 27 publications

References 29 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

Current uses of electro-cautery lumen apposing metal stents in endoscopic ultrasound guided interventions

Living on the EDGE: Preparing for long-term success following EDGE procedure

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