PMID- 35623383
OWN - NLM
STAT- MEDLINE
DCOM- 20220920
LR  - 20221105
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 96
IP  - 4
DP  - 2022 Oct
TI  - EUS-directed transgastric interventions in Roux-en-Y gastric bypass anatomy: a 
      multicenter experience.
PG  - 630-638
LID - S0016-5107(22)01685-6 [pii]
LID - 10.1016/j.gie.2022.05.008 [doi]
AB  - BACKGROUND AND AIMS: Placement of a lumen-apposing metal stent (LAMS) between the 
      gastric pouch and the excluded stomach allows for EUS-guided transgastric 
      interventions (EDGIs) in patients with Roux-en-Y gastric bypass (RYGB). Although 
      EUS-guided transgastric ERCP (EDGE) outcomes have been reported, data are scant 
      on other endoscopic interventions. We aimed to evaluate the outcomes and safety 
      of EDGIs. METHODS: This retrospective study involved 9 centers (United States, 8; 
      Europe, 1) and included patients with RYGB who underwent EDGIs between June 2015 
      and September 2021. The primary outcome was the technical success of EDGIs. 
      Secondary outcomes were adverse events (AEs), length of hospital stay, and 
      fistula follow-up and management. RESULTS: Fifty-four EDGI procedures were 
      performed in 47 patients (mean age, 61 years; 72% women), most commonly for the 
      evaluation of a pancreatic mass (n = 16) and management of pancreatic fluid 
      collections (n = 10). A 20-mm LAMS was used in 26 patients and a 15-mm LAMS in 
      21, creating a gastrogastrostomy in 37 patients and jejunogastrostomy in 10. Most 
      patients (n = 30, 64%) underwent a dual-session EDGI, with a median interval of 
      17 days between the 2 procedures. Single-session EDGI was performed in 17 
      patients, of whom 10 (59%) had anchoring of the LAMS. The most common 
      interventions were diagnostic EUS (with or without FNA or fine-needle biopsy 
      sampling; n = 28) and EUS-guided cystgastrostomy (n = 8). The mean procedural 
      time was 97.6 +/- 78.9 minutes. Technical success was achieved in 52 patients 
      (96%). AEs occurred in 5 patients (10.6%), of which only 1 AE (2.1%) was graded 
      as severe. Intraprocedural LAMS migration was the most common AE, occurring in 3 
      patients (6.4%), whereas delayed spontaneous LAMS migration occurred in 2 (4.3%). 
      Four of the 5 LAMS migration events were managed endoscopically, and 1 required 
      surgical repair. LAMS anchoring was found to be protective against LAMS migration 
      (P = .001). The median duration of hospital stay was 2.1 +/- 3.7 days. Of the 17 
      patients who underwent objective fistula assessment endoscopically or 
      radiologically after LAMS removal, 2 (11.7%) were found to have persistent 
      fistulas. In 1 case the fistula was intentionally left open to assist with weight 
      gain. The other fistula was successfully closed endoscopically. CONCLUSIONS: EDGI 
      is effective and safe for the diagnosis and management of pancreaticobiliary and 
      foregut disorders in RYGB patients. It is associated with high rates of technical 
      success and low rates of severe AEs. LAMS migration is the most common AE with 
      evidence that anchoring can be protective against its occurrence. Persistent 
      fistulas may occur, but endoscopic closure seems to be effective.
CI  - Copyright (c) 2022 American Society for Gastrointestinal Endoscopy. Published by 
      Elsevier Inc. All rights reserved.
FAU - Ghandour, Bachir
AU  - Ghandour B
AD  - Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, 
      Maryland, USA.
FAU - Shinn, Brianna
AU  - Shinn B
AD  - Division of Gastroenterology and Hepatology, Thomas Jefferson University, 
      Philadelphia, Pennsylvania, USA.
FAU - Dawod, Qais M
AU  - Dawod QM
AD  - Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, 
      New York, USA.
FAU - Fansa, Sima
AU  - Fansa S
AD  - Department of Medicine, American University of Beirut Medical Center, Beirut, 
      Lebanon.
FAU - El Chafic, Abdul Hamid
AU  - El Chafic AH
AD  - Division of Gastroenterology and Hepatology, Ochsner Medical Center-New Orleans, 
      New Orleans, Louisiana, USA.
FAU - Irani, Shayan S
AU  - Irani SS
AD  - Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, 
      Seattle, Washington, USA.
FAU - Pawa, Rishi
AU  - Pawa R
AD  - Division of Gastroenterology and Hepatology, Wake Forest Baptist Health, 
      Winston-Salem, North Carolina, USA.
FAU - Gutta, Aditya
AU  - Gutta A
AD  - Division of Gastroenterology and Hepatology, Indiana University Medical Center, 
      Indianapolis, Indiana, USA.
FAU - Ichkhanian, Yervant
AU  - Ichkhanian Y
AD  - Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, 
      Michigan, USA.
FAU - Paranandi, Bharat
AU  - Paranandi B
AD  - Division of Gastroenterology and Hepatology, Leeds Teaching Hospitals NHS Trust, 
      Leeds, Leeds, UK.
FAU - Pawa, Swati
AU  - Pawa S
AD  - Division of Gastroenterology and Hepatology, Wake Forest Baptist Health, 
      Winston-Salem, North Carolina, USA.
FAU - Al-Haddad, Mohammad A
AU  - Al-Haddad MA
AD  - Division of Gastroenterology and Hepatology, Indiana University Medical Center, 
      Indianapolis, Indiana, USA.
FAU - Zuchelli, Tobias
AU  - Zuchelli T
AD  - Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, 
      Michigan, USA.
FAU - Huggett, Matthew T
AU  - Huggett MT
AD  - Division of Gastroenterology and Hepatology, Leeds Teaching Hospitals NHS Trust, 
      Leeds, Leeds, UK.
FAU - Bejjani, Michael
AU  - Bejjani M
AD  - Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, 
      Maryland, USA.
FAU - Sharaiha, Reem Z
AU  - Sharaiha RZ
AD  - Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, 
      New York, USA.
FAU - Kowalski, Thomas E
AU  - Kowalski TE
AD  - Division of Gastroenterology and Hepatology, Thomas Jefferson University, 
      Philadelphia, Pennsylvania, USA.
FAU - Khashab, Mouen A
AU  - Khashab MA
AD  - Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, 
      Maryland, USA.
CN  - EDGI study group
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20220525
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
MH  - Cholangiopancreatography, Endoscopic Retrograde/methods
MH  - Endosonography/methods
MH  - Female
MH  - *Gastric Bypass/adverse effects/methods
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Pancreatic Diseases/surgery
MH  - Retrospective Studies
MH  - Stents
FIR - Zhang, Linda
IR  - Zhang L
FIR - Loren, David E
IR  - Loren DE
FIR - Kumar, Anand
IR  - Kumar A
FIR - Chiang, Austin
IR  - Chiang A
FIR - Schlachterman, Alexander
IR  - Schlachterman A
FIR - Saab, Omar
IR  - Saab O
FIR - Blake, Benjamin
IR  - Blake B
FIR - Obri, Mark S
IR  - Obri MS
FIR - Keane, Margaret G
IR  - Keane MG
FIR - Mony, Shruti
IR  - Mony S
EDAT- 2022/05/28 06:00
MHDA- 2022/09/21 06:00
CRDT- 2022/05/27 19:22
PHST- 2022/03/09 00:00 [received]
PHST- 2022/05/14 00:00 [accepted]
PHST- 2022/05/28 06:00 [pubmed]
PHST- 2022/09/21 06:00 [medline]
PHST- 2022/05/27 19:22 [entrez]
AID - S0016-5107(22)01685-6 [pii]
AID - 10.1016/j.gie.2022.05.008 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2022 Oct;96(4):630-638. doi: 10.1016/j.gie.2022.05.008. Epub 
      2022 May 25.