TY - JOUR
T1 - EUS-directed transenteric ERCP in non–Roux-en-Y gastric bypass surgical anatomy patients (with video)
AU - Ichkhanian, Yervant
AU - Yang, Juliana
AU - James, Theodore W.
AU - Baron, Todd H.
AU - Irani, Shayan
AU - Nasr, John
AU - Sharaiha, Reem Z.
AU - Law, Ryan
AU - Wannhoff, Andreas
AU - Khashab, Mouen A.
N1 - Funding Information:
DISCLOSURE: The following authors disclosed financial relationships: T. H. Baron: Consultant for Boston Scientific, W.L. Gore, Cook Endoscopy, Medtronic, and Olympus America. S. Irani, J. Nasr: Consultant for Boston Scientific. R. Z. Sharaiha: Consultant for Boston Scientific and Apollo Endoscopy R. Law: Consultant for Olympus America. A. Wannhoff: Research grant recipient from Medwork. M. A. Khashab: Consultant for Boston Scientific, Medtronic, and Olympus America; advisory board member for Boston Scientific and Olympus America. All other authors disclosed no financial relationships.
Publisher Copyright:
© 2020 American Society for Gastrointestinal Endoscopy
PY - 2020/5
Y1 - 2020/5
N2 - Background and Aims: Enteroscopy-assisted ERCP is challenging in patients with surgically altered upper GI anatomy. This study evaluated a novel procedure, EUS-directed transenteric ERCP (EDEE), in the de novo creation of an enteroenteric anastomosis for the performance of ERCP in non–Roux-en Y gastric bypass (RYGB) patients. Methods: This was a multicenter retrospective study involving 7 centers between January 2014 and October 2018. Primary outcome was clinical success (completion of EDEE and ERCP with intended interventions), and secondary outcomes were technical success and rate/severity of adverse events. Results: Eighteen patients (mean age, 63 years; 13 women) were included. The most common type of surgical anatomy was Whipple (10/18) and Roux-en-Y hepaticojejunostomy (6/18). Technical success rate of EUS-guided lumen-apposing metal stent (LAMS) placement was 100% and of ERCP was 94.44% (17/18). Fourteen patients underwent separate-session EDEE with a median of 21 days (interquartile range [IQR], 11.5-36) between the 2 procedures. Median total procedure time was 111 minutes (IQR, 81-192). Clinical success and adverse events occurred in 17 (94.4%) and 1 (5.6%; abdominal pain) patients, respectively, during a median follow-up of 88 days (IQR, 54-142). Conclusions: This study suggests that EDEE using LAMSs is feasible and safe in patients with non-RYGB surgical anatomy and complex pancreaticobiliary pathologies.
AB - Background and Aims: Enteroscopy-assisted ERCP is challenging in patients with surgically altered upper GI anatomy. This study evaluated a novel procedure, EUS-directed transenteric ERCP (EDEE), in the de novo creation of an enteroenteric anastomosis for the performance of ERCP in non–Roux-en Y gastric bypass (RYGB) patients. Methods: This was a multicenter retrospective study involving 7 centers between January 2014 and October 2018. Primary outcome was clinical success (completion of EDEE and ERCP with intended interventions), and secondary outcomes were technical success and rate/severity of adverse events. Results: Eighteen patients (mean age, 63 years; 13 women) were included. The most common type of surgical anatomy was Whipple (10/18) and Roux-en-Y hepaticojejunostomy (6/18). Technical success rate of EUS-guided lumen-apposing metal stent (LAMS) placement was 100% and of ERCP was 94.44% (17/18). Fourteen patients underwent separate-session EDEE with a median of 21 days (interquartile range [IQR], 11.5-36) between the 2 procedures. Median total procedure time was 111 minutes (IQR, 81-192). Clinical success and adverse events occurred in 17 (94.4%) and 1 (5.6%; abdominal pain) patients, respectively, during a median follow-up of 88 days (IQR, 54-142). Conclusions: This study suggests that EDEE using LAMSs is feasible and safe in patients with non-RYGB surgical anatomy and complex pancreaticobiliary pathologies.
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U2 - 10.1016/j.gie.2019.12.043
DO - 10.1016/j.gie.2019.12.043
M3 - Article
C2 - 31917168
AN - SCOPUS:85081275083
SN - 0016-5107
VL - 91
SP - 1188-1194.e2
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 5
ER -