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Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE) Utilization of Trends Among Interventional Endoscopists

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Abstract

Background

Endoscopic ultrasound-directed transgastric ERCP (EDGE) has become standard-of-care therapy at many centers for pancreaticobiliary disease in patients with Roux-en-Y Gastric Bypass. In this study, we aimed to evaluate the opinions and practices of endoscopists who perform EDGE.

Methods

A 22-question utilization of EDGE survey was sent to 36 advanced endoscopists at tertiary care centers in the United States. The two-section survey included questions regarding advanced endoscopy volume and training at the respective facilities, and questions on specific details of EDGE utilization.

Results

Among 36 interventional endoscopists (IE) surveyed, 14 (39%) reported performing > 1000 ERCPs annually. Thirty (83%) offered EDGE as an option for Roux-en-Y gastric bypass patients with previous cholecystectomy. Other options offered included: 19 (53%) offered Laparoscopy-assisted ERCP (LA-ERCP), 7 (19%) offered Single-Balloon ERCP (SBE), and 10 (28%) offered percutaneous drainage (PTC). Twenty (56%) IE performed 10 or less EDGE procedures, while 16 (44%) performed 11 or more. Single-session EDGE was performed by 7 (19%) IE, while 15 (42%) performed dual session, and 13 (36%) performed both. 19 (53%) actively closed fistulas while 17 (47%) let them close spontaneously. Thirty one (86%) reported a technical success rate of 91% to 100%. The most frequently reported immediate adverse event post-procedurally was abdominal pain, reported by 17 IE (47%). Weight gain was reported by 2 IE (6%).

Conclusion

EDGE continues to gain in popularity as an option for Roux-en-Y gastric bypass patients requiring pancreaticobiliary interventions, with 24/36 IE (67%) believing that it should be the new standard. In addition, most report a low frequency of post-procedural weight gain.

Clinical Trial Registration

ClinicalTrials.gov Identifier NCT05041608.

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References

  1. Kedia P, Sharaiha RZ, Kumta NA, Kahaleh M. Internal EUS-directed transgastric ERCP (EDGE): game over. Gastroenterology. 2014;147:566–568.

    Article  PubMed  Google Scholar 

  2. Tyberg A, Nieto J, Salgado S, Weaver K, Kedia P, Sharaiha RZ et al. Endoscopic ultrasound (EUS)-directed transgastric endoscopic retrograde cholangiopancreatography or EUS: mid-term analysis of an emerging procedure. Clin Endosc. 2017;50:185–190.

    Article  PubMed  Google Scholar 

  3. Ngamruengphong S, Nieto J, Kunda R, Kumbhari V, Chen YI, Bukhari M et al. Endoscopic ultrasound-guided creation of a transgastric fistula for the management of hepatobiliary disease in patients with Roux-en-Y gastric bypass. Endoscopy. 2017;49:549–552.

    Article  PubMed  Google Scholar 

  4. Kedia P, Tarnasky PR, Nieto J, Steele SL, Siddiqui A, Xu MM et al. EUS-directed transgastric ERCP (EDGE) versus laparoscopy-assisted ERCP (LA-ERCP) for Roux-en-Y Gastric Bypass (RYGB) anatomy: a multicenter early comparative experience of clinical outcomes. J Clin Gastroenterol. 2019;53:304–308.

    Article  PubMed  Google Scholar 

  5. Hsueh W, Krafft MR, Abdelqader A, Nasr J. Su1167 EUS-directed transgastric ercp with 20 mm lumen-apposing metal stents in patients with Roux-EN-Y gastric bypass, are we closer to perfection? Gastrointest Endosc. 2019;89:297.

    Article  Google Scholar 

  6. James TW, Baron TH. Endoscopic ultrasound-directed transgastric ERCP (EDGE): a single-center US experience with follow-up data on fistula closure. Obes Surg. 2019;29:451–456.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wang TJ, Thompson CC, Ryou M. Gastric access temporary for endoscopy (GATE): a proposed algorithm for EUS-directed transgastric ERCP in gastric bypass patients. Surg Endosc. 2019;33:2024–2033.

    Article  PubMed  Google Scholar 

  8. Chiang AL, Gaidhane M, Loren DE, Kahaleh M, Schlachterman A, Millman J et al. 338 Impact of EUS-Directed Transgastric ERCP (edge procedure) access route on technical success and adverse events: a multi-center experience. Gastrointest Endosc 2018;87:70–71.

    Article  Google Scholar 

  9. Runge TM, Kowalski TE, Baron TH, Chiang AL, James T, Schlachterman A et al. 1026 Living on the edge - success, long-term complications, and implications following EUS-directed transgastric ERCP: a multicenter study. Gastrointest Endosc 2019;89:131.

    Article  Google Scholar 

  10. Krafft MR, Hsueh W, James TW, Runge TM, Baron TH, Khashab MA et al. The EDGI new take on EDGE: EUS-directed transgastric intervention (EDGI), other than ERCP, for Roux-en-Y gastric bypass anatomy: a multicenter study. Endosc Int Open. 2019;7:E1231–E1240.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Runge TM, Chiang AL, Kowalski TE, James TW, Baron TH, Nieto J et al. Endoscopic ultrasound-directed transgastric ERCP (EDGE): a retrospective multicenter study. Endoscopy 2021;53:611–618.

    Article  PubMed  Google Scholar 

  12. Bukhari M, Kowalski T, Nieto J, Kunda R, Ahuja NK, Irani S et al. An international, multicenter, comparative trial of EUS-guided gastrogastrostomy-assisted ERCP versus enteroscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Gastrointest Endosc. 2018;88:486–494.

    Article  PubMed  Google Scholar 

  13. Keswani RN, Qumseya BJ, O’Dwyer LC, Wani S. Association between endoscopist and center endoscopic retrograde cholangiopancreatography volume with procedure success and adverse outcomes: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2017;15:1866-1875.e3.

    Article  PubMed  Google Scholar 

  14. Wani S, Han S, Simon V, Hall M, Early D, Aagaard E et al. Setting minimum standards for training in EUS and ERCP: results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees. Gastrointest Endosc. 2019;89:1160-1168.e9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kedia P. Seven years later: do we still have an EDGE? Endoscopy. 2022;54:62–63.

    Article  PubMed  Google Scholar 

  16. Nylund K, Hausken T, Ødegaard S, Eide GE, Gilja OH. Gastrointestinal wall thickness measured with transabdominal ultrasonography and its relationship to demographic factors in healthy subjects. Ultraschall Med Eur J Ultrasound. 2012;33:E225–E232.

    Article  CAS  Google Scholar 

  17. Krafft MR, Lorenze A, Croglio MP, Fang W, Baron TH, Nasr JY. “Innocent as a LAMS”: Does Spontaneous Fistula Closure (Secondary Intention), After EUS-Directed Transgastric ERCP (EDGE) via 20-mm Lumen-Apposing Metal Stent, Confer an Increased Risk of Persistent Fistula and Unintentional Weight Gain? Dig Dis Sci. 2021;

  18. Krafft MR, Fang W, Nasr JY. Shortened-interval dual-session EDGE reduces the risk of LAMS dislodgement while facilitating timely ERCP. Dig Dis Sci 2021;66:2776–2785.

    Article  PubMed  Google Scholar 

  19. Khan MA, Kedia P, Tyberg A, Shrestha S, Ismail MK, Gaidhane M et al. Mo1338 Comparison of EUS directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) with laparoscopic guided endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y Bypass: a meta-analysis. Gastrointest Endosc. 2018;87:AB452–AB453.

    Article  Google Scholar 

  20. Wang TJ, Cortes P, Jirapinyo P, Thompson CC, Ryou M. 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 2021;35:4469–4477.

    Article  PubMed  Google Scholar 

  21. James HJ, James TW, Wheeler SB, Spencer JC, Baron TH. Cost-effectiveness of endoscopic ultrasound-directed transgastric ERCP compared with device-assisted and laparoscopic-assisted ERCP in patients with Roux-en-Y anatomy. Endoscopy. 2019;51:1051–1058.

    Article  PubMed  Google Scholar 

  22. Abu Dayyeh BK, Thompson CC, Gostout C. Endoscopic retrograde cholangiopancreatography after Roux-en-Y gastric bypass: challenges and cautions. Gastroenterology. 2015;148:858–859.

    Article  PubMed  Google Scholar 

  23. Diehl DL, Gabrielsen JD, Strodel WE. The challenges of endoscopic retrograde cholangiopancreatography in gastric bypass patients: the game is not yet over. Gastroenterology. 2015;148:857–858.

    Article  PubMed  Google Scholar 

  24. Tyberg A, Kedia P, Tawadros A, Tarnasky PR, Gaidhane M, Nieto J et al. EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE): the first learning curve. J Clin Gastroenterol. 2020;54:569–572.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA

    Sardar M. Shah-Khan, Eric Zhao, Amy Tyberg, Sardar Sarkar, Haroon M. Shahid, Rodrigo Duarte-Chavez, Monica Gaidhane & Michel Kahaleh

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  1. Sardar M. Shah-Khan
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  2. Eric Zhao
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All authors worked in all 4 aspects of authorship as per ICMJE guidelines.

Corresponding author

Correspondence to Michel Kahaleh.

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Conflict of interest

Amy Tyberg: Consultant for Ninepoint Medical, Endogastric Solutions, Obalon Therapeutics. Avik Sarkar has done consulting work for US Endoscopy and Obalon Therapeutics. Haroon Shahid has done consulting work for US Endoscopy. Michel Kahaleh has received grants support from Boston Scientific, Fujinon, W.L. Gore, Apollo Endosurgery, Cook Endoscopy, Merit Medical, Olympus, ERBE, and MI Tech. He is a consultant for Boston Scientific and Laboratories Inc., ABBvie. None of those funding was related to this paper. All other authors declare that they have no conflicts of interest.

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Appendix: EDGE survey form

Appendix: EDGE survey form

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Shah-Khan, S.M., Zhao, E., Tyberg, A. et al. Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE) Utilization of Trends Among Interventional Endoscopists. Dig Dis Sci 68, 1167–1177 (2023). https://doi.org/10.1007/s10620-022-07650-1

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