Endoscopic ultrasound-directed transgastric ERCP (EDGE) for Roux-en-Y anatomy: a novel technique
| Autor: | Prashant Kedia, Mark Cerefice, Monica Gaidhane, Nikhil A. Kumta, Reem Z. Sharaiha, Subha Sundararajan, Jessica L. Widmer, Michel Kahaleh |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Endoscopic ultrasound medicine.medical_specialty medicine.medical_treatment Operative Time Gastric Bypass Anastomosis Endosonography Esophageal stent Percutaneous endoscopic gastrostomy medicine Humans Surgical Wound Infection Prospective Studies Prospective cohort study Aged Cholangiopancreatography Endoscopic Retrograde Gastrostomy Cholestasis Endoscopic retrograde cholangiopancreatography medicine.diagnostic_test business.industry Gastroenterology Anastomosis Roux-en-Y Anatomy Middle Aged Roux-en-Y anastomosis digestive system diseases Surgery Feasibility Studies Female Stents Radiology business |
| Zdroj: | Endoscopy. 47:159-163 |
| ISSN: | 1438-8812 0013-726X |
| DOI: | 10.1055/s-0034-1390771 |
| Popis: | Background: Patients with Roux-en-Y gastric bypass (RYGB) anatomy pose challenges when endoscopic retrograde cholangiopancreatography (ERCP) is required. Deep enteroscopy-assisted ERCP can allow pancreaticobiliary intervention in these patients, but with limited success. This case series describes endoscopic ultrasound-directed transgastric ERCP (EDGE) for patients following RYGB. Methods: Patients with RYGB anatomy undergoing EDGE at a tertiary care center were included in this prospective single-arm feasibility study. All procedures were performed in two stages. First a 16-Fr percutaneous endoscopic gastrostomy (PEG) was placed in the excluded stomach using endoscopic ultrasound (EUS) guidance. Second, ERCP was performed through the newly fashioned gastrostomy and a transcutaneous fully covered metal esophageal stent. Results: Six patients (5 women, 1 man) with RYGB anatomy underwent EDGE. EUS-guided PEG placement was successful in all six patients (100 %). Antegrade ERCP was successful in all six patients (100 %) with the stages being separated by a mean of 5.8 days. The mean procedure times for the two stages were 81 minutes and 98 minutes. Two patients (33 %) had localized PEG site infections that were managed with oral antibiotics. There were no adverse events related to ERCP. Conclusions: EDGE is both feasible and safe to perform in RYGB patients. Given the high success rates of our recent experience, we suspect that this technique can be performed as a one-stage procedure to provide a cost-effective, minimally invasive option for a common problem in a growing patient population. |
| Databáze: | OpenAIRE |
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