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Review
. 2025 Aug 11;14(16):5675.
doi: 10.3390/jcm14165675.

Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography (EDGE): Techniques, Outcomes and Safety Profiles

Filippo Antonini  1 , Giacomo Emanuele Maria Rizzo  2 , Giuseppe Vanella  3 , Lorenzo Fuccio  4   5 , Andrea Lisotti  6 , Michiel Bronswijk  7   8 , Enrique Pérez-Cuadrado-Robles  9 , Cecilia Binda  10 , Stefano Mazza  11 , Andrea Anderloni  11   12 , Carlo Fabbri  10 , Ilaria Tarantino  2 ; I-EUS Working Group
Affiliations
Review

Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography (EDGE): Techniques, Outcomes and Safety Profiles

Filippo Antonini et al. J Clin Med. .

Abstract

Patients with Roux-en-Y gastric bypass (RYGB) are a significant challenge for endoscopic retrograde cholangiopancreatography (ERCP) due to the altered anatomy. Endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) has emerged as a valuable alternative to standard methods like enteroscopy-assisted (EA-ERCP) and laparoscopy-assisted (LA-ERCP) ERCP. EDGE involves creating a temporary fistula between the gastric pouch and the excluded stomach under EUS guidance, typically using a lumen-apposing metal stent (LAMS). This allows a standard ERCP scope to access the second duodenum and the biliary tree with standard devices. Several studies have investigated the efficacy and safety of this approach, with variations in techniques such as suturing the LAMS to prevent migration. EDGE has demonstrated high technical success rates, and current evidence indicates that it can be performed safely, with acceptable rates of adverse events such as stent migration, bleeding, and perforation, making it the preferred option in referral centers. This comprehensive review aims to provide a concise evaluation of EDGE, its techniques, outcomes, and role in managing biliary and pancreatic disorders in RYGB patients.

Keywords: EDGE; ERCP; EUS; LAMS; endoscopic ultrasound; endoscopic ultrasound directed transgastric endoscopic retrograde cholangiopancreatography; endoscopy; interventional.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(A) Endoscopic ultrasound (EUS) view of the “sand dollar sign” for the identification of the excluded stomach. (B) EUS-guided contrast injection through the needle (red arrow) confirmed access to the gastric remnant by radiological view. (C) A 20 × 10 mm lumen-apposing metal stent (LAMS, red circle) was then placed between the gastric pouch (green arrow) and the excluded stomach (red arrow). (D) Endoscopic view of the excluded stomach through the LAMS. (E) Endoscopic view of the biliary stones extracted through conventional ERCP. (F) Radiologic view of the conventional ERCP conducted by passing a duodenoscope through the LAMS (red arrow).
Figure 2
Figure 2
Decision-making algorithm for selecting single vs. dual-session EDGE procedure.
See this image and copyright information in PMC

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