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A comparison of clinical outcomes and cost utility among laparoscopy, enteroscopy, and temporary gastric access-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy

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Abstract

Background and aims

Gastric Access Temporary for Endoscopy (GATE), also known as EUS-Directed Trangastric ERCP (EDGE), has demonstrated advantages over device-assisted enteroscopy (DAE) and laparoscopic-assisted ERCP (LA-ERCP) for patients with Roux-en-Y gastric bypass (RYGB) anatomy. We aimed to directly compare clinical outcomes and cost utility among the three ERCP modalities.

Methods

Patients with RYGB anatomy who had DAE, LA-ERCP, or GATE from 2009 to 2019 at 2 tertiary centers were included in our review. We measured outcomes in three areas: success rate, post-procedural adverse events (AEs) and hospitalization, and cost utility per Medicare/Medicaid insurance payments.

Results

Cohort Total 130 patients (70 underwent DAE, 42 LA-ERCP, and 18 GATE). Success rate DAE was successful in 59% of patients, compared to success rates of 98 and 100% for LA-ERCP and GATE, respectively (p < 0.001). For DAE, 62% of unsuccessful cases required rescue therapy. Adverse events and hospitalization Patients who underwent GATE had the lowest rate of hospitalization post procedure (44% vs. 77% and 100% for DAE and LA-ERCP, respectively, p < 0.01) and spent the least amount of time hospitalized (median time 0 days vs 2 and 3 days for DAE and LA-ERCP, respectively, p < 0.0001). GATE had lower AE rates than LA-ERCP (6 vs 31%, p = 0.046), and both had similar rates to DAE. Cost utility LA-ERCP carried the highest total procedural and hospitalization cost per Medicare/ Medicaid insurance payments (median payment difference of $9.7 K vs GATE and $7.9 K vs DAE, p < 0.01 for both). Procedural and hospitalization costs were similar between GATE and DAE (p = 0.76).

Conclusions

GATE is a safe modality for ERCP with high success rates in RYGB patients and exhibits the lowest hospitalization time and rate of adverse events when compared to DAE and LA-ERCP. GATE is similar to DAE from a cost utility approach, and both are less costly than LA-ERCP.

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Authors and Affiliations

  1. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Thomas J. Wang

  2. Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, 75 Francis St., Boston, MA, 02115, USA

    Pichamol Jirapinyo, Christopher C. Thompson & Marvin Ryou

  3. Harvard Medical School, Boston, MA, USA

    Thomas J. Wang, Pedro Cortes, Pichamol Jirapinyo, Christopher C. Thompson & Marvin Ryou

  4. Mayo Clinic, Jacksonville, FL, USA

    Pedro Cortes

Authors
  1. Thomas J. Wang
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Corresponding author

Correspondence to Marvin Ryou.

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Disclosures

Pichamol Jirapinyo obtains research support from Apollo Endosurgery, Fractyl, and GI Dynamics. She is a consultant at Endogastric Solutions and GI Dynamics. Christopher C. Thompson obtains research support from and is a consultant at Boston Scientific, Olympus America, Apollo Endosurgery, GI Dynamics, and USGI Medical. He receives additional research support from Aspire Bariatrics and Spatz Medical. In addition, he consults for Fractyl and Medtronics. GI Windows. Marvin Ryou is a consultant for Boston Scientific, Medtronic, Olympus America, Fuji Medical, Enterasense, Lumendi, Pentax Medical Americas, GI Windows. Thomas Wang and Pedro Cortes have no conflicts of interest or financial ties to disclose.

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Wang, T.J., Cortes, P., Jirapinyo, P. et al. A comparison of clinical outcomes and cost utility among laparoscopy, enteroscopy, and temporary gastric access-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Surg Endosc 35, 4469–4477 (2021). https://doi.org/10.1007/s00464-020-07952-3

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  • DOI: https://doi.org/10.1007/s00464-020-07952-3

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