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EUS-directed Transgastric ERCP (EDGE) Versus Laparoscopy-assisted ERCP (LA-ERCP) for Roux-en-Y Gastric Bypass (RYGB) Anatomy

A Multicenter Early Comparative Experience of Clinical Outcomes

Kedia, Prashant, MD*; Tarnasky, Paul R., MD*; Nieto, Jose, MD; Steele, Stephen L., MD*; Siddiqui, Ali, MD; Xu, Ming-ming, MD§; Tyberg, Amy, MD; Gaidhane, Monica, MD; Kahaleh, Michel, MD, AGAF, FACG, FASGE

Journal of Clinical Gastroenterology: April 2019 - Volume 53 - Issue 4 - p 304–308
doi: 10.1097/MCG.0000000000001037
LIVER, PANCREAS & BILIARY TRACT: Original Articles
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Background and Aims: The standard of care for managing pancreaticobiliary disease in altered Roux-en-Y gastric bypass patients is laparoscopy-assisted endoscopic retrograde cholangiopancreatography (LA-ERCP), but is limited by cost and adverse events. Recently a minimally invasive, completely endoscopic approach using endoscopic ultrasound (EUS) directed transgastric ERCP (EDGE) has been described. We aim to compare EDGE to LA-ERCP in this study.

Methods: Patients from May 2005 to June 2017 with Roux-en-Y gastric bypass anatomy having undergone LA-ERCP or EDGE at 4 tertiary centers were captured in a registry. Patient demographics, procedural details, and clinical outcomes were measured for each group.

Results: Seventy-two patients (n=29 EDGE, n=43 LA-ERCP) were included in this study. There was no significant difference in the technical success of EDGE gastrogastric fistula (96.5%) versus LA-gastrostomy creation (100%). The success rate of achieving therapeutic ERCP (EDGE 96.5% vs. LA-ERCP 97.7%) and number of ERCP (EDGE 1.2 vs. LA-ERCP 1.02) needed to achieve clinical resolution was similar between both groups. Adverse event rate for EDGE, 24% (7/29) and LA-ERCP, 19% (8/43) was similar. The total procedure time (73 vs. 184 min) and length of hospital stay (0.8 vs. 2.65 d) was significantly shorter for EDGE compared to LA-ERCP. The overall weight change after EDGE was −6.6 lbs at an average 28-week follow-up.

Conclusions: This study suggests that the EDGE procedure has similar technical success and adverse events compared with LA-ERCP with the benefit of significantly shorter procedure times and hospital stay. EDGE may offer a minimally invasive, effective option, with less resource utilization, and without significant weight gain.

*Department of Gastroenterology, Methodist Dallas Medical Center, Dallas, TX

Advanced Therapeutic Endoscopy Center, Borland Groover Clinic, Jacksonville, FL

Department of Gastroenterology, Thomas Jefferson, Philadelphia, PA

§Weill Cornell Medical Center, New York, NY

Rutgers Robert Wood Johnson, New Brunswick, NJ

ClinicalTrials.gov Identifier: NCT01522573.

P.K., A.T., A.S., P.R.T., M.-m.X, J.N., and S.L.S.: acquisition of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content. M.G.: acquisition of data, interpretation of data, critical revision of the manuscript for important intellectual content, study coordination. M.K.: study concept and design, acquisition of data, critical revision of the manuscript for important intellectual content, study supervision.

M.K.: received grant support from Boston Scientific, Fujinon, EMcison, Xlumena Inc., W.L. Gore, MaunaKea, Apollo Endosurgery, Cook Endoscopy, ASPIRE Bariatrics, GI Dynamics, NinePoint Medical, Merit Medical, Olympus and MI Tech. He is a consultant for Boston Scientific, Xlumena Inc., Concordia Laboratories Inc., ABBvie, and MaunaKea Tech. P.K.: consultant for Boston Scientific, Endogastric solutions and Apollo Endosurgery. A.S.: consultant for Boston Scientific, Cook Endoscopy and Medtronic. He has received research grant support from Boston Scientific and Medtronic. He is a speaker for ABBVIE. P.R.T.: consultant for Boston Scientific. A.T.: consultant for EndoGastric Solutions. The remaining authors declare that they have nothing to disclose.

Address correspondence to: Michel Kahaleh, MD, AGAF, FACG, FASGE, Department of Medicine Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901(e-mail: mkahaleh@gmail.com).

Received October 25, 2017

Accepted March 5, 2018

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