PMID- 32886240
OWN - NLM
STAT- MEDLINE
DCOM- 20211020
LR  - 20211026
IS  - 1432-2218 (Electronic)
IS  - 0930-2794 (Linking)
VI  - 35
IP  - 8
DP  - 2021 Aug
TI  - A comparison of clinical outcomes and cost utility among laparoscopy, 
      enteroscopy, and temporary gastric access-assisted ERCP in patients with 
      Roux-en-Y gastric bypass anatomy.
PG  - 4469-4477
LID - 10.1007/s00464-020-07952-3 [doi]
AB  - BACKGROUND AND AIMS: Gastric Access Temporary for Endoscopy (GATE), also known as 
      EUS-Directed Trangastric ERCP (EDGE), has demonstrated advantages over 
      device-assisted enteroscopy (DAE) and laparoscopic-assisted ERCP (LA-ERCP) for 
      patients with Roux-en-Y gastric bypass (RYGB) anatomy. We aimed to directly 
      compare clinical outcomes and cost utility among the three ERCP modalities. 
      METHODS: Patients with RYGB anatomy who had DAE, LA-ERCP, or GATE from 2009 to 
      2019 at 2 tertiary centers were included in our review. We measured outcomes in 
      three areas: success rate, post-procedural adverse events (AEs) and 
      hospitalization, and cost utility per Medicare/Medicaid insurance payments. 
      RESULTS: Cohort Total 130 patients (70 underwent DAE, 42 LA-ERCP, and 18 GATE). 
      Success rate DAE was successful in 59% of patients, compared to success rates of 
      98 and 100% for LA-ERCP and GATE, respectively (p < 0.001). For DAE, 62% of 
      unsuccessful cases required rescue therapy. Adverse events and hospitalization 
      Patients who underwent GATE had the lowest rate of hospitalization post procedure 
      (44% vs. 77% and 100% for DAE and LA-ERCP, respectively, p < 0.01) and spent the 
      least amount of time hospitalized (median time 0 days vs 2 and 3 days for DAE and 
      LA-ERCP, respectively, p < 0.0001). GATE had lower AE rates than LA-ERCP (6 vs 
      31%, p = 0.046), and both had similar rates to DAE. Cost utility LA-ERCP carried 
      the highest total procedural and hospitalization cost per Medicare/ Medicaid 
      insurance payments (median payment difference of $9.7 K vs GATE and $7.9 K vs 
      DAE, p < 0.01 for both). Procedural and hospitalization costs were similar 
      between GATE and DAE (p = 0.76). CONCLUSIONS: GATE is a safe modality for ERCP 
      with high success rates in RYGB patients and exhibits the lowest hospitalization 
      time and rate of adverse events when compared to DAE and LA-ERCP. GATE is similar 
      to DAE from a cost utility approach, and both are less costly than LA-ERCP.
FAU - Wang, Thomas J
AU  - Wang TJ
AD  - Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
AD  - Harvard Medical School, Boston, MA, USA.
FAU - Cortes, Pedro
AU  - Cortes P
AD  - Harvard Medical School, Boston, MA, USA.
AD  - Mayo Clinic, Jacksonville, FL, USA.
FAU - Jirapinyo, Pichamol
AU  - Jirapinyo P
AD  - Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's 
      Hospital, 75 Francis St., Boston, MA, 02115, USA.
AD  - Harvard Medical School, Boston, MA, USA.
FAU - Thompson, Christopher C
AU  - Thompson CC
AD  - Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's 
      Hospital, 75 Francis St., Boston, MA, 02115, USA.
AD  - Harvard Medical School, Boston, MA, USA.
FAU - Ryou, Marvin
AU  - Ryou M
AUID- ORCID: 0000-0001-8120-6497
AD  - Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's 
      Hospital, 75 Francis St., Boston, MA, 02115, USA. mryou@bwh.harvard.edu.
AD  - Harvard Medical School, Boston, MA, USA. mryou@bwh.harvard.edu.
LA  - eng
PT  - Journal Article
DEP - 20200904
PL  - Germany
TA  - Surg Endosc
JT  - Surgical endoscopy
JID - 8806653
SB  - IM
MH  - Aged
MH  - Cholangiopancreatography, Endoscopic Retrograde
MH  - Endoscopy, Gastrointestinal
MH  - *Gastric Bypass
MH  - Humans
MH  - *Laparoscopy
MH  - Medicare
MH  - Retrospective Studies
MH  - United States
OTO - NOTNLM
OT  - Clinical outcomes
OT  - Cost utility
OT  - Device-assisted enteroscopy
OT  - Gastric access temporary for endoscopy
OT  - Laparoscopic-assisted ERCP
OT  - Roux-en-Y gastric bypass
EDAT- 2020/09/05 06:00
MHDA- 2021/10/21 06:00
CRDT- 2020/09/05 06:00
PHST- 2020/06/10 00:00 [received]
PHST- 2020/08/25 00:00 [accepted]
PHST- 2020/09/05 06:00 [pubmed]
PHST- 2021/10/21 06:00 [medline]
PHST- 2020/09/05 06:00 [entrez]
AID - 10.1007/s00464-020-07952-3 [pii]
AID - 10.1007/s00464-020-07952-3 [doi]
PST - ppublish
SO  - Surg Endosc. 2021 Aug;35(8):4469-4477. doi: 10.1007/s00464-020-07952-3. Epub 2020 
      Sep 4.