Initial United Kingdom experience of endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography

Abstract

Backgrounds/Aims: Gallstone disease is a recognized complication of bariatric surgery. Subsequent management of choledocholithiasis may be challenging due to altered anatomy which may include Roux-en-Y gastric bypass (RYGB). We conducted a retrospective service evaluation study to assess the safety and efficacy of endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) in patients with RYGB anatomy. Methods: All the patients who underwent EDGE for endoscopic retrograde cholangiopancreatography after RYGB at two tertiary care centers in the United Kingdom between January 2020 and October 2021 were included in the study. Clinical and demographic details were recorded for all patients. The primary outcome measures were technical and clinical success. Adverse events were recorded. Hot Axios lumen apposing metal stents measuring 20 mm in diameter and 10 mm in length were used in all the patients for creation of a gastro-gastric or gastro-jejunal fistula. Results: A total of 14 patients underwent EDGE during the study period. The majority of the patients were female (85.7%) and the mean age of patients was 65.8 ± 9.8 years. Technical success was achieved in all but one patient at the first attempt (92.8%) and clinical success was achieved in 100% of the patients. Complications arose in 3 patients with 1 patient experiencing persistent fistula and weight gain. Conclusions: In patients with RYGB anatomy, EDGE facilitated biliary access has a high rate of clinical success with an acceptable safety profile. Adverse events are uncommon and can be managed endoscopically.

Endoscopic-Directed Trans-Gastric Retrograde Cholangiopancreatography in Patients With Roux-en-Y gastric Bypasses

“…The technical success rate was reported for 13 studies 3,5,16–23,25–27 . No heterogeneity was detected among these studies ( P =0.999, I 2 =0%).…”

“…Quality was evaluated as high in 9 studies 3,16,17,19–24 . Details on quality assessment of the included studies are shown in Supplementary Table 1, Supplemental Digital Content 1, http://links.lww.com/JCG/A963.…”

“…The clinical success rate was reported for 7 studies. 5,17,20,22,[25][26][27] No heterogeneity was detected among the studies (P = 0.912, I 2 = 0%). We used a fixed-effects model for calculation and found that the clinical success rate was 94% (95% CI: 90 to 99, I² = 0%) (Fig.…”

“…Of the remaining 53 articles, 39 were excluded because of studies with less than 10 patients, insufficient data, not being in English, patients had not undergone RYGB, or EDGE procedures had not been performed. The remaining 14 studies 3,5,[16][17][18][19][20][21][22][23][24][25][26][27] were considered eligible and subjected to further analysis. Of these, 11 were retrospective and 3 prospective cohort studies, including 5 single-center and 9 multi-center studies.…”

“…Quality was evaluated as high in 9 studies. 3,16,17,[19][20][21][22][23][24] Details on quality assessment of the included studies are shown in Supplementary Table 1, Supplemental Digital Content 1, http://links.lww.com/JCG/A963. The risks of bias in patient selection, index test, reference standard, flow, and timing were low in most studies.…”