Endoscopic ultrasound-directed transgastric ERCP (EDGE) for Roux-en-Y anatomy: a novel technique

Prashant Kedia; Nikhil A. Kumta; Jessica Widmer; Subha Sundararajan; Mark Cerefice; Monica Gaidhane; Reem Sharaiha; Michel Kahaleh

doi:10.1055/s-0034-1390771

Endoscopy, Table of Contents

Endoscopy 2015; 47(02): 159-163
DOI: 10.1055/s-0034-1390771

Innovations and brief communications

Endoscopic ultrasound-directed transgastric ERCP (EDGE) for Roux-en-Y anatomy: a novel technique

Prashant Kedia

¹Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, USA

,

Nikhil A. Kumta

¹Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, USA

,

Jessica Widmer

²Division of Gastroenterology, North Shore-LIJ, Forest Hills Hospital, New York, USA

,

Subha Sundararajan

³Red Bank Gastroenterology, Riverview Medical Center, New Jersey, USA

,

Mark Cerefice

⁴Division of Gastroenterology, Jersey Shore University Medical Center, New Jersey, USA

,

Monica Gaidhane

¹Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, USA

,

Reem Sharaiha

¹Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, USA

,

Michel Kahaleh

¹Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, USA

› Author Affiliations

Abstract

Background: Patients with Roux-en-Y gastric bypass (RYGB) anatomy pose challenges when endoscopic retrograde cholangiopancreatography (ERCP) is required. Deep enteroscopy-assisted ERCP can allow pancreaticobiliary intervention in these patients, but with limited success. This case series describes endoscopic ultrasound-directed transgastric ERCP (EDGE) for patients following RYGB.

Methods: Patients with RYGB anatomy undergoing EDGE at a tertiary care center were included in this prospective single-arm feasibility study. All procedures were performed in two stages. First a 16-Fr percutaneous endoscopic gastrostomy (PEG) was placed in the excluded stomach using endoscopic ultrasound (EUS) guidance. Second, ERCP was performed through the newly fashioned gastrostomy and a transcutaneous fully covered metal esophageal stent.

Results: Six patients (5 women, 1 man) with RYGB anatomy underwent EDGE. EUS-guided PEG placement was successful in all six patients (100 %). Antegrade ERCP was successful in all six patients (100 %) with the stages being separated by a mean of 5.8 days. The mean procedure times for the two stages were 81 minutes and 98 minutes. Two patients (33 %) had localized PEG site infections that were managed with oral antibiotics. There were no adverse events related to ERCP.

Conclusions: EDGE is both feasible and safe to perform in RYGB patients. Given the high success rates of our recent experience, we suspect that this technique can be performed as a one-stage procedure to provide a cost-effective, minimally invasive option for a common problem in a growing patient population.

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References

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