PMID- 35433222
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 2364-3722 (Print)
IS  - 2196-9736 (Electronic)
IS  - 2196-9736 (Linking)
VI  - 10
IP  - 4
DP  - 2022 Apr
TI  - Comparison of endoscopic ultrasound-directed transgastric endoscopic retrograde 
      cholangiopancreatography outcomes using various technical approaches.
PG  - E459-E467
LID - 10.1055/a-1783-9564 [doi]
AB  - Background and study aims  Roux-en-Y gastric bypass presents an anatomic 
      challenge for patients needing ERCP. EUS-directed transgastric ERCP (EDGE) offers 
      high clinical success but carries considerable risk of adverse events (AEs) with 
      no standardized technical approach. In our study, we review the safety and 
      efficacy of our various EDGE technical approaches. Patients and methods  A 
      retrospective single-center study of all patients who underwent EDGE procedures 
      between February 2018 and November 2019. Primary outcomes included comparing the 
      technical and clinical success, AEs, and lumen-apposing metal stent (LAMS) 
      migration rates per access route (gastrogastric vs jejuno-gastric), number of 
      procedure stages (single-stage vs two-stage), and stent size (15 mm vs 20 mm). 
      Secondary outcomes included LAMS migration characteristics and management. 
      Results  Thirty-two EDGE procedures were performed in 29 patients, including 17 
      single-stage and 15 two-stage procedures, 23 gastrogastric, and nine 
      jejuno-gastric routes, fourteen 15-mm and 17 20-mm LAMS. Overall technical and 
      clinical success rates were 96.9 % and 87.1 %, respectively, without any 
      significant difference between groups. The overall AE rate was (34.4 %) and was 
      significantly lower in the 20-mm LAMS group compared to the 15-mm group (17.6 % 
      vs 57.1 %, P  = 0.03). Compared to two-stage procedures, there was no significant 
      difference in AEs with single-stage procedures (35.3 % vs 33.3 %, P  = 0.33). The 
      LAMS migration rate was (25 %) with no significant difference between groups. 
      Most migrations were around the index procedure and managed endoscopically 
      (62.5 %). Conclusions  EDGE offers high clinical success rates but AE rates 
      remain significant. In our series, a 20-mm LAMS resulted in a significantly lower 
      AE rate than the 15-mm LAMS. Large multicenter studies are recommended to 
      identify technical factors leading to an optimal EDGE procedure.
CI  - 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/).
FAU - Bahdi, Firas
AU  - Bahdi F
AD  - Department of Medicine, Baylor College of Medicine, Houston, Texas, United 
      States.
FAU - George, Rollin
AU  - George R
AD  - Department of Medicine, Section of Gastroenterology and Hepatology, Baylor 
      College of Medicine, Houston, Texas, United States.
FAU - Paneerselvam, Kavea
AU  - Paneerselvam K
AD  - Department of Medicine, Baylor College of Medicine, Houston, Texas, United 
      States.
FAU - Nguyen, Dang
AU  - Nguyen D
AD  - Texas Digestive Disease Consultants, Houston, Texas, United States.
FAU - Abidi, Wasif M
AU  - Abidi WM
AD  - Department of Medicine, Section of Gastroenterology and Hepatology, Baylor 
      College of Medicine, Houston, Texas, United States.
AD  - Baylor St Luke's Medical Center, Houston, Texas, United States.
FAU - Othman, Mohamed O
AU  - Othman MO
AD  - Department of Medicine, Section of Gastroenterology and Hepatology, Baylor 
      College of Medicine, Houston, Texas, United States.
AD  - Baylor St Luke's Medical Center, Houston, Texas, United States.
FAU - Raijman, Isaac
AU  - Raijman I
AD  - Department of Medicine, Section of Gastroenterology and Hepatology, Baylor 
      College of Medicine, Houston, Texas, United States.
AD  - Texas Digestive Disease Consultants, Houston, Texas, United States.
LA  - eng
PT  - Journal Article
DEP - 20220414
PL  - Germany
TA  - Endosc Int Open
JT  - Endoscopy international open
JID - 101639919
PMC - PMC9010084
COIS- Competing interests Dr. Othman is a consultant for Boston Scientific, Olympus 
      Corporation of America, Lumendi, ConMed, Apollo, and AbbVie. Dr. Raijman is a 
      consultant for Boston Scientific Corporation, ConMed, Microtech, Pentax, GI 
      Supplies, Ambu, and co-owner of Endorx. Dr. Abidi is a consultant for ConMed.
EDAT- 2022/04/19 06:00
MHDA- 2022/04/19 06:01
PMCR- 2022/04/01
CRDT- 2022/04/18 06:37
PHST- 2021/07/22 00:00 [received]
PHST- 2021/11/26 00:00 [accepted]
PHST- 2022/04/18 06:37 [entrez]
PHST- 2022/04/19 06:00 [pubmed]
PHST- 2022/04/19 06:01 [medline]
PHST- 2022/04/01 00:00 [pmc-release]
AID - 10.1055/a-1783-9564 [doi]
PST - epublish
SO  - Endosc Int Open. 2022 Apr 14;10(4):E459-E467. doi: 10.1055/a-1783-9564. 
      eCollection 2022 Apr.