Abstract
Background and study aims Indications for accessing the duodenum, and/or excluded stomach in Roux-en-Y gastric
bypass (RYGB) patients extend beyond diagnosis and treatment of pancreaticobiliary
maladies. Given the high technical and clinical success of EUS-directed transgastric
ERCP (EDGE) in RYGB anatomy, we adopted this transgastric (anterograde) approach to
evaluate and treat luminal and extraluminal pathology in and around the excluded gut
in RYGB patients. EUS-directed transgastric intervention (“EDGI”), other than ERCP,
is the terminology we have chosen to describe this heterogenous group of transgastric
diagnostic and/or interventional endoscopic procedures (transgastric interventions)
performed via a lumen-apposing mental stent (LAMS) in select patients with RYGB.
Patients and methods A multicenter (n = 4), retrospective study of RYGB patients with suspected luminal
or extraluminal pathology, in or around the duodenum and/or excluded stomach, underwent
EDGI using LAMS between December 2015 and January 2019.
Results A total of 14 patients (78.6 % women; mean age, 55.7 + 12.4 years) underwent EDGI
via LAMS. Technical and clinical success rates of EDGI were 100 %. The most common
transgastric interventions were diagnostic EUS of extraluminal pathology (n = 6, 42.7 %)
and endoscopic biopsy of gastroduodenal luminal abnormalities (n = 5, 35.7 %). Two
moderate-severity adverse events due to LAMS maldeployment occurred during EUS-JG
creation (14.3 %), and each instance was successfully rescued with a bridging stent.
Conclusions A variety of gastroduodenal luminal and extraluminal disorders in RYGB patients can
be effectively diagnosed and managed using EDGI via LAMS.
