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. 2023 Apr;68(4):1167-1177.
doi: 10.1007/s10620-022-07650-1. Epub 2022 Aug 10.

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

Sardar M Shah-Khan  1 , Eric Zhao  1 , Amy Tyberg  1 , Sardar Sarkar  1 , Haroon M Shahid  1 , Rodrigo Duarte-Chavez  1 , Monica Gaidhane  1 , Michel Kahaleh  2
Affiliations

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

Sardar M Shah-Khan et al. Dig Dis Sci. 2023 Apr.

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.

Keywords: EDGE; Endoscopic ultrasound-directed transgastric ERCP; Laparoscopy-assisted ERCP; Pancreaticobiliary; Roux-en-Y gastric bypass.

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