Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography for patients with Roux-en-Y gastric bypass anatomy: technical overview

  • Hirokazu Honda (The Centre for Therapeutic Endoscopy and Endoscopic Oncology and Division of Gastroenterology, St. Michael's Hospital, University of Toronto) ;
  • Jeffrey D. Mosko (The Centre for Therapeutic Endoscopy and Endoscopic Oncology and Division of Gastroenterology, St. Michael's Hospital, University of Toronto) ;
  • Ryosuke Kobayashi (The Centre for Therapeutic Endoscopy and Endoscopic Oncology and Division of Gastroenterology, St. Michael's Hospital, University of Toronto) ;
  • Andras Fecso (The Centre for Therapeutic Endoscopy and Endoscopic Oncology and Division of Gastroenterology, St. Michael's Hospital, University of Toronto) ;
  • Bong Sik Kim (The Centre for Therapeutic Endoscopy and Endoscopic Oncology and Division of Gastroenterology, St. Michael's Hospital, University of Toronto) ;
  • Schoeman Scott (The Centre for Therapeutic Endoscopy and Endoscopic Oncology and Division of Gastroenterology, St. Michael's Hospital, University of Toronto) ;
  • Gary R. May (The Centre for Therapeutic Endoscopy and Endoscopic Oncology and Division of Gastroenterology, St. Michael's Hospital, University of Toronto)
  • Received : 2022.03.28
  • Accepted : 2022.05.06
  • Published : 2022.11.30
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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

References

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