title: EUS-directed transgastric ERCP for Roux-en-Y gastric bypass anatomy: a minimally invasive approach.
abstract: BACKGROUND
  ERCP is challenging in patients with Roux-en-Y gastric bypass. Using EUS to gain access to the excluded stomach and subsequently performing transcutaneous ERCP was described recently.
  
  
  OBJECTIVE
  We describe our initial experience with an internal EUS-directed transgastric ERCP (EDGE) procedure by using a lumen-apposing metal stent (LAMS).
  
  
  METHODS
  Single-center case series.
  
  
  METHODS
  Tertiary center with expertise in EUS-guided procedures.
  
  
  METHODS
  Five patients with Roux-en-Y gastric bypass underwent EDGE via a LAMS.
  
  
  METHODS
  A linear echoendoscope was used to access the excluded stomach. A LAMS was deployed over a wire to create a gastrogastric or jejunogastric fistula. A duodenoscope was then passed through the LAMS and conventional ERCP was performed.
  
  
  METHODS
  Technical and clinical success rates as well as adverse events.
  
  
  RESULTS
  EUS-guided creation of a gastrogastric or jejunogastric fistula via placement of a LAMS was successful in all cases (100%). The ability to perform ERCP through the fashioned fistula during the index procedure was successful in 3 of 5 cases (60%). Two LAMS dislodgments requiring restenting were observed. No major adverse events were observed. No weight regain occurred. The median procedure time was 68.0 minutes.
  
  
  CONCLUSIONS
  Small sample, single-institution experience.
  
  
  CONCLUSIONS
  The internal EDGE procedure may offer a cost-effective, minimally invasive option for a common problem in a growing patient demographic. Further refinement of the technique is required to minimize adverse events. (
  
  
  BACKGROUND
  NCT01522573.).
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Prashant
authors.initials: P
authors.lastname: Kedia
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Tyberg
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Nikhil A
authors.initials: NA
authors.lastname: Kumta
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Kunal
authors.initials: K
authors.lastname: Karia
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D001649:Bile Duct Diseases / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002761:Cholangitis / Q000601:surgery*; D003251:Constriction, Pathologic / Q000601:surgery; D019160:Endosonography / Q000379:methods*; D015390:Gastric Bypass; D005763:Gastroenterostomy; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010195:Pancreatitis / Q000601:surgery*; D016717:Sphincterotomy, Endoscopic / Q000379:methods; D015607:Stents; D013270:Stomach / Q000601:surgery*