title: Endoscopic Ultrasound (EUS)-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography or EUS: Mid-Term Analysis of an Emerging Procedure.
abstract: OBJECTIVE
  Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Rouxen-Y gastric bypass (RYGB) is challenging. Standard ERCP and enteroscopy-assisted ERCP are associated with limited success rates. Laparoscopy- or laparotomy-assisted ERCP yields improved efficacy rates, but with higher complication rates and costs. We present the first multicenter experience regarding the efficacy and safety of endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) or EUS.
  
  
  METHODS
  All patients who underwent EDGE at two academic centers were included. Clinical success was defined as successful ERCP and/or EUS through the use of lumen-apposing metal stents (LAMS). Adverse events related to EDGE were separated from ERCP- or EUS-related complications and were defined as bleeding, stent migration, perforation, and infection.
  
  
  RESULTS
  Sixteen patients were included in the study. Technical success was 100%. Clinical success was 90% (n=10); five patients were awaiting maturation of the fistula tract prior to ERCP or EUS, and one patient had an aborted ERCP due to perforation. One perforation occurred, which was managed endoscopically. Three patients experienced stent dislodgement; all stents were successfully repositioned or bridged with a second stent. Ten patients (62.5%) had their LAMS removed. The average weight change from LAMS insertion to removal was negative 2.85 kg.
  
  
  CONCLUSIONS
  EDGE is an effective, minimally invasive, single-team solution to the difficulties associated with ERCP in patients with RYGB.
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Tyberg
authors.affiliation: Division of Gastroenterology and Hepatology, Borland-Groover Clinic (BGC), Jacksonville, FL, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Nieto
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Salgado
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Weaver
authors.affiliation: Interventional Endoscopy, Methodist Dallas Medical Center, Dallas, TX, USA.
authors.forename: Prashant
authors.initials: P
authors.lastname: Kedia
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
keywords: Cholangiopancreatography, endoscopic retrograde; EUS-directed transgastric ERCP; Gastric bypass; Lumen-apposing metal stent