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Review
. 2022 Nov;55(6):736-741.
doi: 10.5946/ce.2022.114. Epub 2022 Oct 5.

Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography for patients with Roux-en-Y gastric bypass anatomy: technical overview

Hirokazu Honda  1 , Jeffrey D Mosko  1 , Ryosuke Kobayashi  1 , Andras Fecso  1 , Bong Sik Kim  1 , Schoeman Scott  1 , Gary R May  1
Affiliations
Review

Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography for patients with Roux-en-Y gastric bypass anatomy: technical overview

Hirokazu Honda et al. Clin Endosc. 2022 Nov.

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass anatomy is a well-documented challenge. Traditionally, this problem has been overcome with adjunctive techniques, such as device-assisted ERCP, including double-balloon or single-balloon enteroscopy and laparoscopy-assisted transgastric ERCP. Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a novel technique that enables access to the ampulla using a duodenoscope without surgical intervention and has shown high clinical and technical success rates in recent studies. However, this approach is technically demanding, necessitating a thorough understanding of the gastrointestinal anatomy as well as high operator experience. In this review, we provide a technical overview of EDGE in parallel with our personal experience at our center and propose a simple algorithm to select patients for its appropriate application. In conjunction, the outcomes of EDGE compared with those of device-assisted and laparoscopy-assisted transgastric ERCP will be discussed.

Keywords: Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography; Gastric bypass.

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Conflict of interest statement

Conflicts of Interest

The authors have no potential conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Overview of endoscopic ultrasound-directed transgastric ERCP (EDGE) in Roux-en-Y gastric bypass: gastro-gastrostomy. Adapted from Khara et al. Curr Gastroenterol Rep 2021;23:10, according to the Creative Commons license.
Fig. 2.
Fig. 2.
Algorithm to assist in determining the use of ERCP for patients with Roux-en-Y gastric bypass (RYGB). ERCP, endoscopic retrograde cholangiopancreatography; LA, laparoscopy-assisted transgastric; DA, device-assisted; EDGE, endoscopic ultrasound-directed transgastric ERCP.
See this image and copyright information in PMC

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