Cargando…

The EDGI new take on EDGE: EUS-directed transgastric intervention (EDGI), other than ERCP, for Roux-en-Y gastric bypass anatomy: a multicenter study

Background and study aims  Indications for accessing the duodenum, and/or excluded stomach in Roux-en-Y gastric bypass (RYGB) patients extend beyond diagnosis and treatment of pancreaticobiliary maladies. Given the high technical and clinical success of EUS-directed transgastric ERCP (EDGE) in RYGB...

Descripción completa

Detalles Bibliográficos
Autores principales: Krafft, Matthew R., Hsueh, William, James, Theodore W., Runge, Thomas M., Baron, Todd H., Khashab, Mouen A., Irani, Shayan S., Nasr, John Y.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: © Georg Thieme Verlag KG 2019
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6773567/
https://www.ncbi.nlm.nih.gov/pubmed/31579704
http://dx.doi.org/10.1055/a-0915-2192
_version_ 1783455907573661696
author Krafft, Matthew R.
Hsueh, William
James, Theodore W.
Runge, Thomas M.
Baron, Todd H.
Khashab, Mouen A.
Irani, Shayan S.
Nasr, John Y.
author_facet Krafft, Matthew R.
Hsueh, William
James, Theodore W.
Runge, Thomas M.
Baron, Todd H.
Khashab, Mouen A.
Irani, Shayan S.
Nasr, John Y.
author_sort Krafft, Matthew R.
collection PubMed
description Background and study aims  Indications for accessing the duodenum, and/or excluded stomach in Roux-en-Y gastric bypass (RYGB) patients extend beyond diagnosis and treatment of pancreaticobiliary maladies. Given the high technical and clinical success of EUS-directed transgastric ERCP (EDGE) in RYGB anatomy, we adopted this transgastric (anterograde) approach to evaluate and treat luminal and extraluminal pathology in and around the excluded gut in RYGB patients. EUS-directed transgastric intervention (“EDGI”), other than ERCP, is the terminology we have chosen to describe this heterogenous group of transgastric diagnostic and/or interventional endoscopic procedures (transgastric interventions) performed via a lumen-apposing mental stent (LAMS) in select patients with RYGB. Patients and methods  A multicenter (n = 4), retrospective study of RYGB patients with suspected luminal or extraluminal pathology, in or around the duodenum and/or excluded stomach, underwent EDGI using LAMS between December 2015 and January 2019. Results  A total of 14 patients (78.6 % women; mean age, 55.7 + 12.4 years) underwent EDGI via LAMS. Technical and clinical success rates of EDGI were 100 %. The most common transgastric interventions were diagnostic EUS of extraluminal pathology (n = 6, 42.7 %) and endoscopic biopsy of gastroduodenal luminal abnormalities (n = 5, 35.7 %). Two moderate-severity adverse events due to LAMS maldeployment occurred during EUS-JG creation (14.3 %), and each instance was successfully rescued with a bridging stent. Conclusions  A variety of gastroduodenal luminal and extraluminal disorders in RYGB patients can be effectively diagnosed and managed using EDGI via LAMS.
format Online
Article
Text
id pubmed-6773567
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher © Georg Thieme Verlag KG
record_format MEDLINE/PubMed
spelling pubmed-67735672019-10-02 The EDGI new take on EDGE: EUS-directed transgastric intervention (EDGI), other than ERCP, for Roux-en-Y gastric bypass anatomy: a multicenter study Krafft, Matthew R. Hsueh, William James, Theodore W. Runge, Thomas M. Baron, Todd H. Khashab, Mouen A. Irani, Shayan S. Nasr, John Y. Endosc Int Open Background and study aims  Indications for accessing the duodenum, and/or excluded stomach in Roux-en-Y gastric bypass (RYGB) patients extend beyond diagnosis and treatment of pancreaticobiliary maladies. Given the high technical and clinical success of EUS-directed transgastric ERCP (EDGE) in RYGB anatomy, we adopted this transgastric (anterograde) approach to evaluate and treat luminal and extraluminal pathology in and around the excluded gut in RYGB patients. EUS-directed transgastric intervention (“EDGI”), other than ERCP, is the terminology we have chosen to describe this heterogenous group of transgastric diagnostic and/or interventional endoscopic procedures (transgastric interventions) performed via a lumen-apposing mental stent (LAMS) in select patients with RYGB. Patients and methods  A multicenter (n = 4), retrospective study of RYGB patients with suspected luminal or extraluminal pathology, in or around the duodenum and/or excluded stomach, underwent EDGI using LAMS between December 2015 and January 2019. Results  A total of 14 patients (78.6 % women; mean age, 55.7 + 12.4 years) underwent EDGI via LAMS. Technical and clinical success rates of EDGI were 100 %. The most common transgastric interventions were diagnostic EUS of extraluminal pathology (n = 6, 42.7 %) and endoscopic biopsy of gastroduodenal luminal abnormalities (n = 5, 35.7 %). Two moderate-severity adverse events due to LAMS maldeployment occurred during EUS-JG creation (14.3 %), and each instance was successfully rescued with a bridging stent. Conclusions  A variety of gastroduodenal luminal and extraluminal disorders in RYGB patients can be effectively diagnosed and managed using EDGI via LAMS. © Georg Thieme Verlag KG 2019-10 2019-10-01 /pmc/articles/PMC6773567/ /pubmed/31579704 http://dx.doi.org/10.1055/a-0915-2192 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Krafft, Matthew R.
Hsueh, William
James, Theodore W.
Runge, Thomas M.
Baron, Todd H.
Khashab, Mouen A.
Irani, Shayan S.
Nasr, John Y.
The EDGI new take on EDGE: EUS-directed transgastric intervention (EDGI), other than ERCP, for Roux-en-Y gastric bypass anatomy: a multicenter study
title The EDGI new take on EDGE: EUS-directed transgastric intervention (EDGI), other than ERCP, for Roux-en-Y gastric bypass anatomy: a multicenter study
title_full The EDGI new take on EDGE: EUS-directed transgastric intervention (EDGI), other than ERCP, for Roux-en-Y gastric bypass anatomy: a multicenter study
title_fullStr The EDGI new take on EDGE: EUS-directed transgastric intervention (EDGI), other than ERCP, for Roux-en-Y gastric bypass anatomy: a multicenter study
title_full_unstemmed The EDGI new take on EDGE: EUS-directed transgastric intervention (EDGI), other than ERCP, for Roux-en-Y gastric bypass anatomy: a multicenter study
title_short The EDGI new take on EDGE: EUS-directed transgastric intervention (EDGI), other than ERCP, for Roux-en-Y gastric bypass anatomy: a multicenter study
title_sort edgi new take on edge: eus-directed transgastric intervention (edgi), other than ercp, for roux-en-y gastric bypass anatomy: a multicenter study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6773567/
https://www.ncbi.nlm.nih.gov/pubmed/31579704
http://dx.doi.org/10.1055/a-0915-2192
work_keys_str_mv AT krafftmatthewr theedginewtakeonedgeeusdirectedtransgastricinterventionedgiotherthanercpforrouxenygastricbypassanatomyamulticenterstudy
AT hsuehwilliam theedginewtakeonedgeeusdirectedtransgastricinterventionedgiotherthanercpforrouxenygastricbypassanatomyamulticenterstudy
AT jamestheodorew theedginewtakeonedgeeusdirectedtransgastricinterventionedgiotherthanercpforrouxenygastricbypassanatomyamulticenterstudy
AT rungethomasm theedginewtakeonedgeeusdirectedtransgastricinterventionedgiotherthanercpforrouxenygastricbypassanatomyamulticenterstudy
AT barontoddh theedginewtakeonedgeeusdirectedtransgastricinterventionedgiotherthanercpforrouxenygastricbypassanatomyamulticenterstudy
AT khashabmouena theedginewtakeonedgeeusdirectedtransgastricinterventionedgiotherthanercpforrouxenygastricbypassanatomyamulticenterstudy
AT iranishayans theedginewtakeonedgeeusdirectedtransgastricinterventionedgiotherthanercpforrouxenygastricbypassanatomyamulticenterstudy
AT nasrjohny theedginewtakeonedgeeusdirectedtransgastricinterventionedgiotherthanercpforrouxenygastricbypassanatomyamulticenterstudy
AT krafftmatthewr edginewtakeonedgeeusdirectedtransgastricinterventionedgiotherthanercpforrouxenygastricbypassanatomyamulticenterstudy
AT hsuehwilliam edginewtakeonedgeeusdirectedtransgastricinterventionedgiotherthanercpforrouxenygastricbypassanatomyamulticenterstudy
AT jamestheodorew edginewtakeonedgeeusdirectedtransgastricinterventionedgiotherthanercpforrouxenygastricbypassanatomyamulticenterstudy
AT rungethomasm edginewtakeonedgeeusdirectedtransgastricinterventionedgiotherthanercpforrouxenygastricbypassanatomyamulticenterstudy
AT barontoddh edginewtakeonedgeeusdirectedtransgastricinterventionedgiotherthanercpforrouxenygastricbypassanatomyamulticenterstudy
AT khashabmouena edginewtakeonedgeeusdirectedtransgastricinterventionedgiotherthanercpforrouxenygastricbypassanatomyamulticenterstudy
AT iranishayans edginewtakeonedgeeusdirectedtransgastricinterventionedgiotherthanercpforrouxenygastricbypassanatomyamulticenterstudy
AT nasrjohny edginewtakeonedgeeusdirectedtransgastricinterventionedgiotherthanercpforrouxenygastricbypassanatomyamulticenterstudy