Open Access
CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(05): E529-E537
DOI: 10.1055/a-2057-5984
Original article

Endoscopic ultrasound-directed transgastric ERCP (EDGE): A multicenter US study on long-term follow-up and fistula closure

Prashant Kedia
 1   Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
,
Sardar Shah-Khan
 2   Rutgers Robert Wood Johnson Medical School – Gastroenterology, New Brunswick, New Jersey, United States
,
Amy Tyberg
 3   Weill Cornell Medical College – Gastroenterology & Hepatology, New York, New York, United States
,
Monica Gaidhane
 1   Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
,
Avik Sarkar
 1   Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
,
Haroon Shahid
 1   Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
,
Eric Zhao
 1   Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
,
Shyam Thakkar
 4   West Virginia University – Gastroenterology, New Brunswick, New Jersey, United States
,
Mason Winkie
 4   West Virginia University – Gastroenterology, New Brunswick, New Jersey, United States
,
 5   Ruby Memorial Hospital – Digestive Diseases, Morgantown, West Virginia, United States
,
Shailendra Singh
 5   Ruby Memorial Hospital – Digestive Diseases, Morgantown, West Virginia, United States
,
Eugene Zolotarevsky
 6   Spectrum Health Butterworth Hospital – Advanced Endoscopy/Gastroenterology, Grand Rapids, Michigan, United States
,
Jeremy Barber
 6   Spectrum Health Butterworth Hospital – Advanced Endoscopy/Gastroenterology, Grand Rapids, Michigan, United States
,
Mitchelle Zolotarevsky
 6   Spectrum Health Butterworth Hospital – Advanced Endoscopy/Gastroenterology, Grand Rapids, Michigan, United States
,
Ian Greenberg
 1   Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
,
Dhiemeziem Eke
 1   Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
,
David Lee
 1   Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
,
Frank Gress
 7   Icahn School of Medicine at Mount Sinai – Gastroenterology, New York, New York, United States
,
Iman Andalib
 8   Robert Wood Johnson Health System – Gastroenterology, New Brunswick, New Jersey, United States
,
Gregory Bills
 9   University of Kentucky Medical Center – Gastroenterology, New Brunswick, Kentucky, United States
,
 9   University of Kentucky Medical Center – Gastroenterology, New Brunswick, Kentucky, United States
,
10   Tanta University Faculty of Medicine – Gastroenterology and Hepatology – Internal Medicine, Tanta, Egypt
,
11   Sharp Grassmont Hospital – Gastroenterology/Internal Medicine, Mesa, California, United States
,
Enrique Vazquez-Sequeiros
12   University Hospital Ramon y Cajal – Division of Gastroenterology, Madrid, Sapin
,
13   Beth Israel Deaconess Medical Center – Gastroenterology, Boston, Massachusetts, United States
,
Neal Mehta
13   Beth Israel Deaconess Medical Center – Gastroenterology, Boston, Massachusetts, United States
,
Allison Schulman
14   University of Michigan Medicine – Gastroenterology, New Brunswick, Michigan, United States
,
Richard Kwon
15   University of Michigan Health System – Gastroenterology, Ann Arbor, Michigan, United States
,
16   University of Michigan Michigan Medicine – Internal Medicine, Ann Arbor, Michigan, United States
,
John Nasr
 4   West Virginia University – Gastroenterology, New Brunswick, New Jersey, United States
,
 2   Rutgers Robert Wood Johnson Medical School – Gastroenterology, New Brunswick, New Jersey, United States
› Author Affiliations
TRIAL REGISTRATION: Multi-center retrospective study NCT05051358 at ClinicalTrials.gov (http://www.clinicaltrials.gov/)
Preview

Abstract

Background and study aims Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a safe and efficacious procedure to treat pancreaticobiliary diseases in Roux-en-Y gastric bypass (RYGB). This multicenter study aimed to determine the long-term outcomes of EDGE focusing on fistula persistence rates and post-procedure weight change.

Patients and methods Information about patients with Roux-en-Y gastric bypass anatomy who underwent EDGE between 2015 and 2021 from 10 institutions was captured in a registry. Patient demographics, procedural details, and clinical outcomes were analyzed.

Results One hundred seventy-two patients were included in the study (mean age 60, 25 % male). Technical success of lumen-apposing metal stent (LAMS) placement was 171 of 172 (99.4 %) while clinical success of intervention was 95%. The mean procedure time was 65 minutes. The most commonly reported complication was stent dislodgement/migration (n = 29, 17). Mean length of time of LAMS duration was 69 days. Mean follow-up time was 6 months. Endoscopic fistula closure was performed in 40 % of patients (69/172) at the time of LAMS removal. Persistence of fistula was observed in 19 of 62 patients (31 %) assessed. Length of LAMS indwell time (days) was a predictor of persistent fistula. The average weight gain while the LAMS was in place was 12 lb in 63 patients (36.6 %); 59.4 % of patients gained < 5 lb.

Conclusions EDGE is a safe and efficacious procedure for RYGB patients requiring ERCP. Post-procedure evaluation and management of the enteral fistula varies widely among centers currently and would benefit from further standardization. Fistula persistence appears to be uncommon and can be managed endoscopically but may be related to length of indwell times of the LAMS.



Publication History

Received: 08 September 2022

Accepted after revision: 09 March 2023

Article published online:
26 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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