Endoscopic ultrasound-directed transgastric ERCP in patients with Roux-en-Y gastric bypass using lumen-apposing metal stents or duodenal self-expandable metal stents. A European single-center experience.

Introduction: endoscopic ultrasound-directed transgastric ERCP (EDGE) is emerging in Roux-en-Y gastric bypass. Methods: a single-center review of 14 consecutive patients to assess EDGE outcomes. Results: fourteen EUS-directed gastro-gastrostomy/gastro-jejunostomy were performed using lumen-apposing metal stents (LAMS, n = 10) or duodenal self-expandable metal stents (SEMS, n = 4). Single-session ERCP was clinically successful in 9/12 (75 %) cases and subsequent deferred or follow-up procedures in 6/7 (85 %). Papillary access and duct cannulation were obtained in all. One migrated biliary stent failed to be removed, with clinically successful EDGE in 13/14(93 %). Dislodgment occurred in 4/19 patients and was successfully managed endoscopically.Three (16 %) mild adverse events developed. Transgastric stents were removed after a median of 30 days. No symptom recurrence or fistula were noted a median of 256 days post-transgastric stet-removal. Conclusions: duodenal SEMS and LAMS can be used for either single- or deferred EDGE in Roux-en-Y gastric bypass.