Shortened-Interval Dual-Session EDGE Reduces the Risk of LAMS Dislodgement While Facilitating Timely ERCP

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 2020 Aug 21

PMID 32816212

Citations 6

Authors

Matthew R Krafft

Wei Fang

John Y Nasr

Affiliations

Soon will be listed here.

Abstract

Background And Aims: EUS-directed transgastric ERCP (EDGE) is an endoscopic modality for treating pancreaticobiliary disorders after Roux-en-Y gastric bypass. EDGE consists of EUS-directed gastrogastrostomy/jejunogastrostomy creation (EUS-GG; step 1), followed by transgastric ERCP (step 2). The two steps can be performed in the same or separate endoscopic session(s). Single-session EDGE is immediately therapeutic but risks perforation via LAMS dislodgement. Dual-session EDGE does not risk perforation, but the clinical malady festers during the 10-14-day interval required for fistula maturation. A "shortened-interval dual-session" EDGE (2-4 day interval) may resolve this dilemma. Our study compares 20-mm LAMS dislodgement risk between single-session and shortened-interval dual-session EDGE.

Methods: We conducted a single-center retrospective study of 21 RYGB patients who underwent EDGE using 20-mm LAMS by one advanced endoscopist between 3/2018 and 2/2020. Given the small sample size, a permutation of regressor residuals test was conducted to investigate the association between EDGE interval type and LAMS dislodgement, controlling for the effect of fistula type.

Results: Eleven patients (six female; mean age 55 years old) underwent single-session EDGE; LAMS dislodgement occurred in five cases (45%). Ten patients (eight female; mean age 60 years old) underwent shortened-interval dual-session EDGE (median interval 2 days); LAMS dislodgement occurred in one case (10%). The odds of LAMS dislodgement during single-session EDGE was 817% that of shortened-interval dual-session EDGE (OR 8.17; p = 0.05), after controlling for the effect of fistula type.

Conclusions: Shortened-interval dual-session EDGE decreases the risk of intraprocedural 20-mm LAMS dislodgement while allowing for timely transgastric ERCP.

Citing Articles

Understanding the Role of Different ERCP Techniques in Post-Roux-en-Y Gastric Bypass Patients: a Systematic Review and Meta-analysis.

Gellert B, Rancz A, Hoferica J, Teutsch B, Sipos Z, Veres D Obes Surg. 2024; 35(1):285-304.

PMID: 39671059 PMC: 11717856. DOI: 10.1007/s11695-024-07459-z.

Laparoscopic-Assisted Endoscopic Retrograde Cholangiopancreatography (ERCP) Versus Endoscopic Ultrasound-Directed Transgastric ERCP in Patients With Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis.

De Oliveira V, De Moura D, Do Monte Junior E, Proenca I, Ribeiro I, Sanchez-Luna S Cureus. 2022; 14(10):e30196.

PMID: 36381817 PMC: 9649332. DOI: 10.7759/cureus.30196.

Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE) Utilization of Trends Among Interventional Endoscopists.

Shah-Khan S, Zhao E, Tyberg A, Sarkar S, Shahid H, Duarte-Chavez R Dig Dis Sci. 2022; 68(4):1167-1177.

PMID: 35947304 DOI: 10.1007/s10620-022-07650-1.

Endoscopic management of difficult common bile duct stones: Where are we now? A comprehensive review.

Tringali A, Costa D, Fugazza A, Colombo M, Khalaf K, Repici A World J Gastroenterol. 2021; 27(44):7597-7611.

PMID: 34908801 PMC: 8641054. DOI: 10.3748/wjg.v27.i44.7597.

"Innocent as a LAMS": Does Spontaneous Fistula Closure (Secondary Intention), After EUS-Directed Transgastric ERCP (EDGE) via 20-mm Lumen-Apposing Metal Stent, Confer an Increased Risk of Persistent Fistula and Unintentional Weight Gain?.

Krafft M, Lorenze A, Croglio M, Fang W, Baron T, Nasr J Dig Dis Sci. 2021; 67(6):2337-2346.

PMID: 34189668 PMC: 8714861. DOI: 10.1007/s10620-021-07003-4.

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