Background and Aims
ERCP is challenging in patients with Roux-en-Y gastric bypass (RYGB) anatomy. EUS-guided
gastrogastrostomy (GG) creation is a promising novel technique to access the excluded
stomach to facilitate conventional ERCP. We aimed to compare procedural outcomes and
adverse events (AEs) between EUS-guided GG-assisted ERCP (EUS-GG-ERCP) and enteroscopy-assisted
ERCP (e-ERCP) in patients with RYGB.
Methods
Patients with RYGB anatomy who underwent EUS-GG-ERCP or e-ERCP between 2014 and 2016
at 5 tertiary centers were included. The primary outcome was technical success of
ERCP, defined as successful cannulation of the selected duct with successful intervention
as intended. Secondary outcomes included total procedural time (in the EUS-GG group,
total procedural time included EUS-GG creation plus ERCP procedure time), length of
hospital stay, and rate/severity of AEs graded according to the American Society for
Gastrointestinal Endoscopy lexicon.
Results
A total of 60 patients (mean age, 57.2 ± 13.2; 75% women) were included, of whom 30
(50%) underwent EUS-GG-ERCP and 30 (50%) underwent e-ERCP (double-balloon enteroscope
ERCP, 19; single-balloon enteroscope ERCP, 11). The technical success rate was significantly
higher in the EUS-GG-ERCP versus the e-ERCP group (100% vs 60.0%, P < .001). Total procedure time was significantly shorter in patients who underwent
EUS-GG-ERCP (49.8 minutes vs 90.7 minutes, P < .001). Postprocedure median length of hospitalization was shorter in the EUS-GG
group (1 vs 10.5 days, P = .02). Rate of AEs was similar in both groups (10% vs 6.7%, P = 1).
Conclusions
EUS-GG-ERCP may be superior to e-ERCP in patients with RYGB anatomy in terms of a
higher technical success and shorter procedural times and offers a similar safety
profile.
Graphical abstract
Graphical Abstract
Abbreviations:
AE (adverse event), ASGE (American Society for Gastrointestinal Endoscopy), e-ERCP (enteroscopy-assisted ERCP), EUS-GG-ERCP (EUS-guided gastrogastrostomy-assisted ERCP), GG (gastrogastrostomy), LAMS (lumen-apposing metallic stent), OTSC (over-the-scope clip), RYGB (Roux-en-Y gastric bypass)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: May 03, 2018
Accepted:
April 24,
2018
Received:
April 14,
2017
Footnotes
DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: T. Kowalski: Consultant for Boston Scientific and Medtronic. J. Nieto: Consultant and speaker for Boston Scientific; consultant, speaker, and medical advisory board member for Medtronic. R. Kunda: Consultant, speaker, and medical advisory board member for Boston Scientific; consultant for Omega Imaging; consultant and speaker for BCM Korea and Olympus. N. Ahuja: Speaker for Medtronic. S. Irani: Consultant for Boston Scientific. Y-I Chen: Consultant for Boston Scientific. V. Kumbhari: Consultant for Boston Scientific, Reshape Life Science, Medtronic, Pentax Medical. and Apollo Endosurgery. V. Singh: Consultant for Akeca Therapeutics, AbbVie. and Ariel Precision Medicine. M. A. Khashab: Consultant for Boston Scientific, Olympus, and Medtronic; medical advisory board member for Boston Scientific and Olympus. All other authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Khashab at [email protected] .
Identification
Copyright
© 2018 by the American Society for Gastrointestinal Endoscopy
ScienceDirect
Access this article on ScienceDirectLinked Article
- ERCP in patients with Roux-en-Y gastric bypass: one size does not fit allGastrointestinal EndoscopyVol. 89Issue 3
- PreviewThe study by Bukhari et al1 comparing EUS-guided gastrostomy-assisted ERCP (EUS-GG-ERCP) versus enteroscopy-assisted ERCP (e-ERCP) in patients with Roux-en-Y gastric bypass (RYGB) contributes new and important information on the care of these challenging patients. Technical success was significantly higher with EUS-GG-ERCP (100% vs 60%; P < .001), whereas procedure time and hospital stay were significantly lower. The adverse events rate was similar in the 2 groups (10% vs 6.7%; P = 1).
- Full-Text
- Preview
- Effective newly developed short-type double-balloon endoscope for ERCP in patients with Roux-en-Y gastric bypassGastrointestinal EndoscopyVol. 89Issue 4
- PreviewWe read with interest the article by Bukhari et al1 on a comparative trial of EUS-guided gastrogastrostomy-assisted ERCP (EUS-GG-ERCP) versus enteroscopy-assisted ERCP (e-ERCP) in patients with Roux-en-Y gastric bypass (RYGB) under general anesthesia. In EUS-GG-ERCP, a duodenoscope was passed through the gastrogastrostomy (GG) created by a lumen-apposing metallic stent (LAMS) into the excluded stomach. Although the authors concluded that EUS-GG-ERCP may be superior to e-ERCP in RYGB patients, the main drawback of EUS-GG-ERCP is to require 4 procedural sessions (GG creation, ERCP, LAMS removal with GG closure, and confirmation of GG closure) in most RYGB patients.
- Full-Text
- Preview
