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

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 2022 Aug 10

PMID 35947304

Authors

Sardar M Shah-Khan

Eric Zhao

Amy Tyberg

Sardar Sarkar

Haroon M Shahid

Rodrigo Duarte-Chavez

Monica Gaidhane

Michel Kahaleh

Affiliations

Soon will be listed here.

Abstract

Background: Endoscopic ultrasound-directed transgastric ERCP (EDGE) has become standard-of-care therapy at many centers for pancreaticobiliary disease in patients with Roux-en-Y Gastric Bypass. In this study, we aimed to evaluate the opinions and practices of endoscopists who perform EDGE.

Methods: A 22-question utilization of EDGE survey was sent to 36 advanced endoscopists at tertiary care centers in the United States. The two-section survey included questions regarding advanced endoscopy volume and training at the respective facilities, and questions on specific details of EDGE utilization.

Results: Among 36 interventional endoscopists (IE) surveyed, 14 (39%) reported performing > 1000 ERCPs annually. Thirty (83%) offered EDGE as an option for Roux-en-Y gastric bypass patients with previous cholecystectomy. Other options offered included: 19 (53%) offered Laparoscopy-assisted ERCP (LA-ERCP), 7 (19%) offered Single-Balloon ERCP (SBE), and 10 (28%) offered percutaneous drainage (PTC). Twenty (56%) IE performed 10 or less EDGE procedures, while 16 (44%) performed 11 or more. Single-session EDGE was performed by 7 (19%) IE, while 15 (42%) performed dual session, and 13 (36%) performed both. 19 (53%) actively closed fistulas while 17 (47%) let them close spontaneously. Thirty one (86%) reported a technical success rate of 91% to 100%. The most frequently reported immediate adverse event post-procedurally was abdominal pain, reported by 17 IE (47%). Weight gain was reported by 2 IE (6%).

Conclusion: EDGE continues to gain in popularity as an option for Roux-en-Y gastric bypass patients requiring pancreaticobiliary interventions, with 24/36 IE (67%) believing that it should be the new standard. In addition, most report a low frequency of post-procedural weight gain.

Clinical Trial Registration: ClinicalTrials.gov Identifier NCT05041608.

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References

Kedia P, Sharaiha R, Kumta N, Kahaleh M . Internal EUS-directed transgastric ERCP (EDGE): game over. Gastroenterology. 2014; 147(3):566-8. DOI: 10.1053/j.gastro.2014.05.045. View

Tyberg A, Nieto J, Salgado S, Weaver K, Kedia P, Sharaiha R . Endoscopic Ultrasound (EUS)-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography or EUS: Mid-Term Analysis of an Emerging Procedure. Clin Endosc. 2016; 50(2):185-190. PMC: 5398356. DOI: 10.5946/ce.2016.030. View

Ngamruengphong S, Nieto J, Kunda R, Kumbhari V, Chen Y, Bukhari M . Endoscopic ultrasound-guided creation of a transgastric fistula for the management of hepatobiliary disease in patients with Roux-en-Y gastric bypass. Endoscopy. 2017; 49(6):549-552. DOI: 10.1055/s-0043-105072. View

Kedia P, Tarnasky P, Nieto J, Steele S, Siddiqui A, Xu M . EUS-directed Transgastric ERCP (EDGE) Versus Laparoscopy-assisted ERCP (LA-ERCP) for Roux-en-Y Gastric Bypass (RYGB) Anatomy: A Multicenter Early Comparative Experience of Clinical Outcomes. J Clin Gastroenterol. 2018; 53(4):304-308. DOI: 10.1097/MCG.0000000000001037. View

James T, Baron T . Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE): a Single-Center US Experience with Follow-up Data on Fistula Closure. Obes Surg. 2018; 29(2):451-456. PMC: 6550479. DOI: 10.1007/s11695-018-3531-2. View

Wang T, Thompson C, Ryou M . Gastric access temporary for endoscopy (GATE): a proposed algorithm for EUS-directed transgastric ERCP in gastric bypass patients. Surg Endosc. 2019; 33(6):2024-2033. DOI: 10.1007/s00464-019-06715-z. View

Krafft M, Hsueh W, James T, Runge T, Baron T, Khashab M . The EDGI new take on EDGE: EUS-directed transgastric intervention (EDGI), other than ERCP, for Roux-en-Y gastric bypass anatomy: a multicenter study. Endosc Int Open. 2019; 7(10):E1231-E1240. PMC: 6773567. DOI: 10.1055/a-0915-2192. View

Runge T, Chiang A, Kowalski T, James T, Baron T, Nieto J . Endoscopic ultrasound-directed transgastric ERCP (EDGE): a retrospective multicenter study. Endoscopy. 2020; 53(6):611-618. DOI: 10.1055/a-1254-3942. View

Bukhari M, Kowalski T, Nieto J, Kunda R, Ahuja N, Irani S . An international, multicenter, comparative trial of EUS-guided gastrogastrostomy-assisted ERCP versus enteroscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Gastrointest Endosc. 2018; 88(3):486-494. DOI: 10.1016/j.gie.2018.04.2356. View

10.

Keswani R, Qumseya B, ODwyer L, Wani S . Association Between Endoscopist and Center Endoscopic Retrograde Cholangiopancreatography Volume With Procedure Success and Adverse Outcomes: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2017; 15(12):1866-1875.e3. DOI: 10.1016/j.cgh.2017.06.002. View

11.

Wani S, Han S, Simon V, Hall M, Early D, Aagaard E . Setting minimum standards for training in EUS and ERCP: results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees. Gastrointest Endosc. 2019; 89(6):1160-1168.e9. PMC: 6527477. DOI: 10.1016/j.gie.2019.01.030. View

12.

Kedia P . Seven years later: do we still have an EDGE?. Endoscopy. 2021; 54(1):62-63. DOI: 10.1055/a-1453-0606. View

13.

Krafft M, Fang W, Nasr J . Shortened-Interval Dual-Session EDGE Reduces the Risk of LAMS Dislodgement While Facilitating Timely ERCP. Dig Dis Sci. 2020; 66(8):2776-2785. PMC: 7895849. DOI: 10.1007/s10620-020-06551-5. View

14.

Wang T, Cortes P, Jirapinyo P, Thompson C, Ryou M . 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. Surg Endosc. 2020; 35(8):4469-4477. DOI: 10.1007/s00464-020-07952-3. View

15.

James H, James T, Wheeler S, Spencer J, Baron T . Cost-effectiveness of endoscopic ultrasound-directed transgastric ERCP compared with device-assisted and laparoscopic-assisted ERCP in patients with Roux-en-Y anatomy. Endoscopy. 2019; 51(11):1051-1058. DOI: 10.1055/a-0938-3918. View

16.

Abu Dayyeh B, Thompson C, Gostout C . Endoscopic Retrograde Cholangiopancreatography After Roux-en-Y Gastric Bypass: Challenges and Cautions. Gastroenterology. 2015; 148(4):858-9. DOI: 10.1053/j.gastro.2014.11.051. View

17.

Diehl D, Gabrielsen J, Strodel W . The challenges of endoscopic retrograde cholangiopancreatography in gastric bypass patients: the game is not yet over. Gastroenterology. 2015; 148(4):857-8. DOI: 10.1053/j.gastro.2014.11.052. View

18.

Tyberg A, Kedia P, Tawadros A, Tarnasky P, Gaidhane M, Nieto J . EUS-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography (EDGE): The First Learning Curve. J Clin Gastroenterol. 2020; 54(6):569-572. DOI: 10.1097/MCG.0000000000001326. View