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Original article Clinical endoscopy| Volume 94, ISSUE 4, P727-732, October 2021

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Maximizing success in single-session EUS-directed transgastric ERCP: a retrospective cohort study to identify predictive factors of stent migration

Published:May 03, 2021DOI:https://doi.org/10.1016/j.gie.2021.04.022
Maximizing success in single-session EUS-directed transgastric ERCP: a retrospective cohort study to identify predictive factors of stent migration
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      Background and Aims

      EUS-directed transgastric ERCP (the EDGE procedure) is a simplified method of performing ERCP in Roux-en-Y gastric bypass patients. The EDGE procedure involves placement of a lumen-apposing metal stent (LAMS) into the excluded stomach to serve as a conduit for passage of the duodenoscope for pancreatobiliary intervention. Originally a multistep process, urgent indications for ERCP have led to the development of single-session EDGE (SS-EDGE) with LAMS placement and ERCP performed in the same session. The goal of this study was to identify predictive factors of intraprocedural LAMS migration in SS-EDGE.

      Methods

      We conducted a multicenter retrospective review that included 9 tertiary medical centers across the United States. Data were collected and analyzed from 128 SS-EDGE procedures. The primary outcome was intraprocedural LAMS migration. Secondary outcomes were other procedural adverse events such as bleeding and perforation.

      Results

      Eleven LAMS migrations were observed in 128 procedures (8.6%). Univariate analysis of clinically relevant variables was performed, as was a binary logistic regression analysis of stent diameter and stent dilation. This revealed that use of a smaller (15 mm) diameter LAMS was an independent predictor of intraprocedural stent migration (odds ratio, 5.36; 95% confidence interval, 1.29-22.24; P = .021). Adverse events included 3 patients who required surgery and 2 who experienced intraprocedural bleeding.

      Conclusions

      Use of a larger-diameter LAMS is a predictive factor for a nonmigrated stent and improved procedural success in SS-EDGE. Although larger patient cohorts are needed to adequately assess these findings, performance of LAMS dilation and fixation may also decrease risk of intraprocedural LAMS migration and improve procedural success.

      Graphical abstract

      Figure thumbnail fx1
      Graphical Abstract

      Abbreviations:

      BAE-ERCP (balloon-assisted ERCP), EDGE (EUS-directed transgastric ERCP), LAMS (lumen-apposing metal stent), SS-EDGE (single-session EUS-directed transgastric ERCP)
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      Article info

      Publication history

      Published online: May 03, 2021
      Accepted: April 27, 2021
      Received: January 18, 2021

      Footnotes

      DISCLOSURE: The following authors disclosed financial relationships: I. Raijman: Advisory committee for Boston Scientific; speaker and teacher for Conmed and GI Supply; other activities for EndoRX. J. Nieto, B. Confer, T. Zuchelli, A. Chiang: Consultant for Boston Scientific and Olympus. H. S. Khara: Consultant for Boston Scientific; speaker and teacher for Conmed, Olympus America, and Medtronic; grant support from Pentax. D. L. Diehl: Consultant for Boston Scientific, GI Supply, Medtronic, and Olympus; speaker and teacher for Cook Medical, DiLumen, Pentax, and Steris Endoscopy; advisory committee for Cernostics. V. Kumbhari: Consultant for Boston Scientific, Apollo Endosurgery, Fujifilm, Medtronic, Obalon Therapeutics, Pentax Medical, ReShape Medical, and LifeSciences; board member of ABE; grant support from Apollo Endosurgery and ERBE. M. Khashab, T. Kowalski: Consultant for Boston Scientific and Medtronic. A. Tyberg: Consultant for Boston Scientific and Endogastric Solutions. M. Kahaleh: Consultant for Boston Scientific and Abbvie; grant support from Boston Scientific, Conmed, Cook Medical, Gore, Interscope, Merit, Olympus, and Pinnacle. C. Piraka: Research grant support from Aries and US Endoscopy. R. Law: Consultant for Olympus America; other activities for UpToDate. P. Kedia: Consultant for Apollo Endosurgery, Boston Scientific, Medtronic, and Olympus. A. Schlachterman: Consultant for Conmed, Lumendi, and Medtronic. D. Loren: Consultant for Boston Scientific, Olympus America, and Pinnacle Biologics; grant support from Medtronic. All other authors disclosed no financial relationships.

      If you would like to chat with an author of this article, you may contact Dr Shinn at [email protected]

      Identification

      DOI: https://doi.org/10.1016/j.gie.2021.04.022

      Copyright

      © 2021 by the American Society for Gastrointestinal Endoscopy

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      Linked Article

      • EUS-directed transgastric ERCP: Why so on EDGE?
        Gastrointestinal EndoscopyVol. 94Issue 6
        • Preview
          EUS-directed transgastric ERCP (EDGE) has become a viable therapeutic option in patients with Roux-en-Y gastric bypass (RYGB) anatomy, especially in patients with a history of cholecystectomy.1,2 This technique seems to have overcome the suboptimal efficacy of enteroscopy-assisted ERCP and the safety issues concerning laparoscopy-assisted ERCP, respectively.2-5
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