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SAME-SESSION ENDOSCOPIC ULTRASOUND DIRECTED TRANSGASTRIC INTERVENTION (EDGI) IN PATIENTS WITH RYGB ANATOMY: A MULTICENTER STUDY

Published:October 08, 2022DOI:https://doi.org/10.1016/j.gie.2022.10.004
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      ABSTRACT

      Background and Aims

      Endoscopic ultrasound-directed transgastric intervention (EDGI) is an established technique for the management of pancreaticobiliary pathology in Roux-en-Y gastric bypass (RYGB) patients. There is an inherent risk of intraprocedural stent dislodgement leading to perforation. The procedure is therefore often performed in two stages, 2-4 weeks apart, to allow for fistula maturation to mitigate the risk of LAMS dislodgment. However, some clinical indications such as cholangitis, require more urgent intervention rendering this approach impractical. The aim of this study is to evaluate the safety and efficacy of same-session EDGI with fixation of a 20mm LAMS using endoscopic suturing.

      Methods

      Two-center, retrospective study of consecutive RYGB patients who underwent same-session EDGI using a sutured 20mm LAMS between February 2018 and May 2020. Patient demographics, procedural details and clinical outcomes were recorded.

      Results

      A total of 37 patients (mean age 58.1 years, 86.5% female) underwent same-session EDGI with a median follow-up of 31.8 months. Procedural intervention was ERCP in 33 (89.2%) and ERCP with EUS in 4 (10.8%) cases. Technical success was 100%. Access was via gastrogastric fistula in 26 (70.3%) and jejunogastric fistula in 11 (29.7%) cases. The LAMS was anchored with two endoscopic sutures in 33 (89.2%) and one suture in 4 (10.8%) cases. Adverse events occurred in 4 (10.8%) patients (3 post procedural bleeding, 1 cholangitis). There were no episodes of stent dislodgement, or delayed stent migration. A persistent fistula was diagnosed in 7 (18.9%) patients that underwent objective testing (n= 28, 75.7%) of which 6 were successfully closed endoscopically.

      Conclusions

      Single stage EDGI via a sutured 20mm LAMS was associated with high rate of technical success, low rates of adverse events and no episodes of stent migration. Persistent fistulas although common, were amenable to endoscopic management.

      Keywords

      Abbreviations:

      BMI (body mass index), AEs (adverse events), LAMS (lumen-apposing metal stent), OTSC (over-the-scope clip), EUS (endoscopic ultrasound), EGDI (endoscopic ultrasound directed transgastric interventions), EDGE (endoscopic ultrasound directed transgastric endoscopic retrograde cholangiopancreatography), ERCP (Endoscopic retrograde cholangiopancreatography), APC (Argon plasma coagulation), RYGB (Roux-en-Y gastric bypass), UGI (Upper gastrointestinal)
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