Clin Endosc.  2022 Nov;55(6):736-741. 10.5946/ce.2022.114.

Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography for patients with Roux-en-Y gastric bypass anatomy: technical overview

• Honda H
• Mosko JD
• Kobayashi R
• Fecso A
• Kim BS
• Scott S
• May GR

• KMID: 2536070
• DOI: http://doi.org/10.5946/ce.2022.114

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass anatomy is a well-documented challenge. Traditionally, this problem has been overcome with adjunctive techniques, such as device-assisted ERCP, including double-balloon or single-balloon enteroscopy and laparoscopy-assisted transgastric ERCP. Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a novel technique that enables access to the ampulla using a duodenoscope without surgical intervention and has shown high clinical and technical success rates in recent studies. However, this approach is technically demanding, necessitating a thorough understanding of the gastrointestinal anatomy as well as high operator experience. In this review, we provide a technical overview of EDGE in parallel with our personal experience at our center and propose a simple algorithm to select patients for its appropriate application. In conjunction, the outcomes of EDGE compared with those of device-assisted and laparoscopy-assisted transgastric ERCP will be discussed.

Keyword

Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography; Endoscopic retrograde cholangiopancreatography; Roux-en-Y gastric bypass

Figure

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  Fig. 1. Overview of endoscopic ultrasound-directed transgastric ERCP (EDGE) in Roux-en-Y gastric bypass: gastro-gastrostomy. Adapted from Khara et al. Curr Gastroenterol Rep 2021;23:10, according to the Creative Commons license.5

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  Fig. 2. Algorithm to assist in determining the use of ERCP for patients with Roux-en-Y gastric bypass (RYGB). ERCP, endoscopic retrograde cholangiopancreatography; LA, laparoscopy-assisted transgastric; DA, device-assisted; EDGE, endoscopic ultrasound-directed transgastric ERCP.

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