Mo1338 COMPARISON OF EUS DIRECTED TRANSGASTRIC ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (EDGE) WITH LAPAROSCOPIC GUIDED ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN PATIENTS WITH ROUX-EN-Y BYPASS: A META-ANALYSIS

Khan, Muhammad Ali; Kedia, Prashant; Tyberg, Amy; Shrestha, Shreesh; Ismail, Mohammad K.; Gaidhane, Monica; Tarnasky, Paul R.; Kahaleh, Michel

doi:10.1016/j.gie.2018.04.1988

Cited by 5 publications

(3 citation statements)

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“…In 2018, a meta-analysis comparing LA-ERCP and EDGE including 941 patients (843 LA-ERCP and 98 EDGE) showed pooled technical and clinical success rates similar in both of the groups (98% vs. 96%, p = 0.07 and 96% vs. 96%, p = 0.84). AE rate had no significant difference (13% vs. 10%, p = 0.32) [ 71 ]. Data reported by Khara et al confirmed a high success rate among 76 patients in both those who performed LA-ERCP and EDGE (both 100%), with no significant difference in adverse events rate (17%vs.…”

Section: Resultsmentioning

confidence: 99%

Biliopancreatic Endoscopy in Altered Anatomy

Tarantino

Rizzo

2021

Medicina

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Background and Objectives: Anatomical post-surgical alterations of the upper gastrointestinal (GI) tract have always been challenging for performing diagnostic and therapeutic endoscopy, especially when biliopancreatic diseases are involved. Esophagectomy, gastrectomy with various reconstructions and pancreaticoduodenectomy are among the most common surgeries causing upper GI tract alterations. Technological improvements and new methods have increased the endoscopic success rate in these patients, and the literature has been rapidly increasing over the past few years. The aim of this systematic review is to identify evidence on the available biliopancreatic endoscopic techniques performed in the altered post-surgical anatomy of upper GI tract. Materials and Methods: We performed a systematic search of PubMed, MEDLINE, Cochrane Library, and SCOPUS databases. Study-level variables extracted were the last name of the first author, publication year, study design, number of patients, type of post-surgical anatomical alteration, endoscopic technique, success rate and endoscopic-related adverse events. Results: Our primary search identified 221 titles, which was expanded with studies after the citation search. The final full-text review process identified 52 articles (31 retrospective studies, 8 prospective studies and 13 case reports). We found several different techniques developed over the years for biliopancreatic diseases in altered anatomy, in order to perform both endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). They included enteroscopy-assisted ERCP (double and single balloon enteroscopy-ERCP, spiral enteroscopy-ERCP) laparoscopic assisted ERCP, EUS-Directed transgastric ERCP, EUS-directed transgastric intervention, gastric access temporary for endoscopy, and percutaneous assisted trans prosthetic endoscopic therapy. The success rate was high (most of the techniques showed a success rate over 90%) and a low rate of adverse events were reported. Conclusions: We suggest the considerationof the novel techniques when approaching patients with altered anatomy who require biliopancreatic endoscopy, focusing on the surgery type, success rate and adverse events reported in the literature.

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Section: Resultsmentioning

confidence: 99%

Biliopancreatic Endoscopy in Altered Anatomy

Tarantino

Rizzo

2021

Medicina

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“…All EDGE-related studies have demonstrated higher technical (100%) and clinical success rates (60%–100%) [ 41 – 47 , 54 ]. EDGE has similar success rates (96.5% vs 100% p = 0.40) as compared to LA-ERCP in achieving therapeutic ERCP, but appears superior when compared to DAE (100% vs 60%, p < 0.001) [ 48 – 50 ]. Although LA-ERCP and EDGE have similar success rates, EDGE has shorter procedure time (73 vs 184 min, p < 0.00001) and post procedural hospital stay (0.8 vs 2.65 d, p < 0.00008) [ 49 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

“…Technical and clinical success rates were similar in both the groups (98% vs 96% p = 0.07 and 96% vs 96% p = 0.84) without any significant difference in the adverse event rate (13% vs 10%, p = 0.32). However, pooled mean length of stay and procedure time were shorter with EDGE (1.1 vs 3.1 days and 43 min vs 166 min) [ 50 ].…”

Section: Advanced Endoscopy Techniquesmentioning

confidence: 99%

Review of ERCP Techniques in Roux-en-Y Gastric Bypass Patients: Highlight on the Novel EUS-Directed Transgastric ERCP (EGDE) Technique

Khara

Parvataneni

Park

et al. 2021

Curr Gastroenterol Rep

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Purpose of Review Hepatobiliary complications are common in Roux-en-Y gastric bypass (RYGB) patients. Despite development of multiple surgical and endoscopic access techniques over the years, ERCP using standard duodenoscope remains challenging in these patients due to the altered anatomy. Recent Findings Limited success with enteroscope-assisted and laparoscope-assisted ERCP led to the evolution of the novel EUS-directed transgastric ERCP (EDGE) procedure, with variations of this technique termed as Gastric Access Temporary for Endoscopy (GATE), EUS-guided TransGastric ERCP (EUS-TG-ERCP), EUS-guided GastroGastrostomy-assisted ERCP (EUS-GG-ERCP), and EUS-directed transgastric intervention (EDGI). EDGE has high technical (100%) and clinical success rates (60–100%), lower adverse event rate (1.5–7.6%), and up to 20% access stent migration rate; without any significant weight changes. EDGE has significantly shorter procedure time (73vs184min), post-procedural hospital stays (0.8vs2.65 days) and is more cost effective compared to other modalities. Summary EDGE technique addresses the challenges of RYGB anatomy as a minimally invasive, clinically successful, fully endoscopic, and cost-effective option. We present a literature review of the EDGE technique from its inception to current, in addition to reviewing other access techniques, their advantages, disadvantages and outcomes.

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