Abstract
Background and study aims Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a new endoscopic procedure
to perform ERCP in Roux-en-y gastric bypass (RYGB) patients. The aim of this study
was to conduct a systematic review and meta-analysis to evaluate technical success,
clinical success and adverse effects of EDGE and compare it to laparoscopic ERCP (LA-ERCP)
and balloon ERCP (BE-ERCP).
Patients and methods We conducted a comprehensive search of several databases and conference proceedings
including PubMed, EMBASE, Google-Scholar, LILACS, SCOPUS, and Web of Science databases
to identify studies reporting on EDGE, LA-ERCP, and BE-ERCP. The primary outcome was
to evaluate technical and clinical success of all three procedures and the secondary
analysis focused on calculating the pooled rate of all adverse events (AEs), along
with the commonly reported AE subtypes.
Results Twenty-four studies on 1268 patients were included in our analysis with the majority
of the population being males with mean age 53.72 years. Pooled rates of technical
and clinical success with EDGE wer 95.5 % and 95.9 %, with LA-ERCP were 95.3 % and
92.9 % and were BE-ERCP were 71.4 % and 58.7 %, respectively. Pooled rates of all
AEs with EDGE were 21.9 %, with LA-ERCP 17.4 % and with BE-ERCP 8.4 %. Stent migration
was the most common AE with EDGE with 13.3 % followed by bleeding with 6.6 %.
Conclusion Our meta-analysis demonstrated that the technical and clinical success of EDGE procedure
is better than BE-ERCP and comparable to that of LA-ERCP in RYGB patients. EDGE also
has a similar safety profile as compared to LA-ERCP but has higher AE rate as compared
to BE-ERCP.
