EUS-directed transgastric ERCP for Roux-en-Y gastric bypass anatomy: A minimally invasive approach

Prashant Kedia, Amy Tyberg, Nikhil A. Kumta, Monica Gaidhane, Kunal Karia, Reem Z. Sharaiha, Michel Kahaleh

Research output: Contribution to journalArticlepeer-review

57 Scopus citations


Background ERCP is challenging in patients with Roux-en-Y gastric bypass. Using EUS to gain access to the excluded stomach and subsequently performing transcutaneous ERCP was described recently. Objective We describe our initial experience with an internal EUS-directed transgastric ERCP (EDGE) procedure by using a lumen-apposing metal stent (LAMS). Design Single-center case series. Setting Tertiary center with expertise in EUS-guided procedures. Patients Five patients with Roux-en-Y gastric bypass underwent EDGE via a LAMS. Interventions A linear echoendoscope was used to access the excluded stomach. A LAMS was deployed over a wire to create a gastrogastric or jejunogastric fistula. A duodenoscope was then passed through the LAMS and conventional ERCP was performed. Main Outcome Measurements Technical and clinical success rates as well as adverse events. Results EUS-guided creation of a gastrogastric or jejunogastric fistula via placement of a LAMS was successful in all cases (100%). The ability to perform ERCP through the fashioned fistula during the index procedure was successful in 3 of 5 cases (60%). Two LAMS dislodgments requiring restenting were observed. No major adverse events were observed. No weight regain occurred. The median procedure time was 68.0 minutes. Limitations Small sample, single-institution experience. Conclusion The internal EDGE procedure may offer a cost-effective, minimally invasive option for a common problem in a growing patient demographic. Further refinement of the technique is required to minimize adverse events. (Clinical trial registration number: NCT01522573.)

Original languageEnglish (US)
Pages (from-to)560-565
Number of pages6
JournalGastrointestinal Endoscopy
Issue number3
StatePublished - Sep 1 2015
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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