An international, multicenter, comparative trial of EUS-guided gastrogastrostomy-assisted ERCP versus enteroscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy

Majidah Bukhari, Thomas Kowalski, Jose Nieto, Rastislav Kunda, Nitin K. Ahuja, Shayan Irani, Apeksha Shah, David Loren, Olaya Brewer, Omid Sanaei, Yen I. Chen, Saowanee Ngamruengphong, Vivek Kumbhari, Vikesh Singh, Hanaa Dakour Aridi, Mouen Khashab

Research output: Contribution to journalArticle

Abstract

Background and Aims: ERCP is challenging in patients with Roux-en-Y gastric bypass (RYGB) anatomy. EUS-guided gastrogastrostomy (GG) creation is a promising novel technique to access the excluded stomach to facilitate conventional ERCP. We aimed to compare procedural outcomes and adverse events (AEs) between EUS-guided GG-assisted ERCP (EUS-GG-ERCP) and enteroscopy-assisted ERCP (e-ERCP) in patients with RYGB. Methods: Patients with RYGB anatomy who underwent EUS-GG-ERCP or e-ERCP between 2014 and 2016 at 5 tertiary centers were included. The primary outcome was technical success of ERCP, defined as successful cannulation of the selected duct with successful intervention as intended. Secondary outcomes included total procedural time (in the EUS-GG group, total procedural time included EUS-GG creation plus ERCP procedure time), length of hospital stay, and rate/severity of AEs graded according to the American Society for Gastrointestinal Endoscopy lexicon. Results: A total of 60 patients (mean age, 57.2 ± 13.2; 75% women) were included, of whom 30 (50%) underwent EUS-GG-ERCP and 30 (50%) underwent e-ERCP (double-balloon enteroscope ERCP, 19; single-balloon enteroscope ERCP, 11). The technical success rate was significantly higher in the EUS-GG-ERCP versus the e-ERCP group (100% vs 60.0%, P <.001). Total procedure time was significantly shorter in patients who underwent EUS-GG-ERCP (49.8 minutes vs 90.7 minutes, P <.001). Postprocedure median length of hospitalization was shorter in the EUS-GG group (1 vs 10.5 days, P =.02). Rate of AEs was similar in both groups (10% vs 6.7%, P = 1). Conclusions: EUS-GG-ERCP may be superior to e-ERCP in patients with RYGB anatomy in terms of a higher technical success and shorter procedural times and offers a similar safety profile.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Gastric Bypass
Endoscopic Retrograde Cholangiopancreatography
Multicenter Studies
Anatomy
Length of Stay
Gastrointestinal Endoscopy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

An international, multicenter, comparative trial of EUS-guided gastrogastrostomy-assisted ERCP versus enteroscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. / Bukhari, Majidah; Kowalski, Thomas; Nieto, Jose; Kunda, Rastislav; Ahuja, Nitin K.; Irani, Shayan; Shah, Apeksha; Loren, David; Brewer, Olaya; Sanaei, Omid; Chen, Yen I.; Ngamruengphong, Saowanee; Kumbhari, Vivek; Singh, Vikesh; Aridi, Hanaa Dakour; Khashab, Mouen.

In: Gastrointestinal Endoscopy, 01.01.2018.

Research output: Contribution to journalArticle

Bukhari, Majidah ; Kowalski, Thomas ; Nieto, Jose ; Kunda, Rastislav ; Ahuja, Nitin K. ; Irani, Shayan ; Shah, Apeksha ; Loren, David ; Brewer, Olaya ; Sanaei, Omid ; Chen, Yen I. ; Ngamruengphong, Saowanee ; Kumbhari, Vivek ; Singh, Vikesh ; Aridi, Hanaa Dakour ; Khashab, Mouen. / An international, multicenter, comparative trial of EUS-guided gastrogastrostomy-assisted ERCP versus enteroscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. In: Gastrointestinal Endoscopy. 2018.
@article{42130b9754ad4d19ba91814ee5f9d870,
title = "An international, multicenter, comparative trial of EUS-guided gastrogastrostomy-assisted ERCP versus enteroscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy",
abstract = "Background and Aims: ERCP is challenging in patients with Roux-en-Y gastric bypass (RYGB) anatomy. EUS-guided gastrogastrostomy (GG) creation is a promising novel technique to access the excluded stomach to facilitate conventional ERCP. We aimed to compare procedural outcomes and adverse events (AEs) between EUS-guided GG-assisted ERCP (EUS-GG-ERCP) and enteroscopy-assisted ERCP (e-ERCP) in patients with RYGB. Methods: Patients with RYGB anatomy who underwent EUS-GG-ERCP or e-ERCP between 2014 and 2016 at 5 tertiary centers were included. The primary outcome was technical success of ERCP, defined as successful cannulation of the selected duct with successful intervention as intended. Secondary outcomes included total procedural time (in the EUS-GG group, total procedural time included EUS-GG creation plus ERCP procedure time), length of hospital stay, and rate/severity of AEs graded according to the American Society for Gastrointestinal Endoscopy lexicon. Results: A total of 60 patients (mean age, 57.2 ± 13.2; 75{\%} women) were included, of whom 30 (50{\%}) underwent EUS-GG-ERCP and 30 (50{\%}) underwent e-ERCP (double-balloon enteroscope ERCP, 19; single-balloon enteroscope ERCP, 11). The technical success rate was significantly higher in the EUS-GG-ERCP versus the e-ERCP group (100{\%} vs 60.0{\%}, P <.001). Total procedure time was significantly shorter in patients who underwent EUS-GG-ERCP (49.8 minutes vs 90.7 minutes, P <.001). Postprocedure median length of hospitalization was shorter in the EUS-GG group (1 vs 10.5 days, P =.02). Rate of AEs was similar in both groups (10{\%} vs 6.7{\%}, P = 1). Conclusions: EUS-GG-ERCP may be superior to e-ERCP in patients with RYGB anatomy in terms of a higher technical success and shorter procedural times and offers a similar safety profile.",
author = "Majidah Bukhari and Thomas Kowalski and Jose Nieto and Rastislav Kunda and Ahuja, {Nitin K.} and Shayan Irani and Apeksha Shah and David Loren and Olaya Brewer and Omid Sanaei and Chen, {Yen I.} and Saowanee Ngamruengphong and Vivek Kumbhari and Vikesh Singh and Aridi, {Hanaa Dakour} and Mouen Khashab",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.gie.2018.04.2356",
language = "English (US)",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - An international, multicenter, comparative trial of EUS-guided gastrogastrostomy-assisted ERCP versus enteroscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy

AU - Bukhari, Majidah

AU - Kowalski, Thomas

AU - Nieto, Jose

AU - Kunda, Rastislav

AU - Ahuja, Nitin K.

AU - Irani, Shayan

AU - Shah, Apeksha

AU - Loren, David

AU - Brewer, Olaya

AU - Sanaei, Omid

AU - Chen, Yen I.

AU - Ngamruengphong, Saowanee

AU - Kumbhari, Vivek

AU - Singh, Vikesh

AU - Aridi, Hanaa Dakour

AU - Khashab, Mouen

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background and Aims: ERCP is challenging in patients with Roux-en-Y gastric bypass (RYGB) anatomy. EUS-guided gastrogastrostomy (GG) creation is a promising novel technique to access the excluded stomach to facilitate conventional ERCP. We aimed to compare procedural outcomes and adverse events (AEs) between EUS-guided GG-assisted ERCP (EUS-GG-ERCP) and enteroscopy-assisted ERCP (e-ERCP) in patients with RYGB. Methods: Patients with RYGB anatomy who underwent EUS-GG-ERCP or e-ERCP between 2014 and 2016 at 5 tertiary centers were included. The primary outcome was technical success of ERCP, defined as successful cannulation of the selected duct with successful intervention as intended. Secondary outcomes included total procedural time (in the EUS-GG group, total procedural time included EUS-GG creation plus ERCP procedure time), length of hospital stay, and rate/severity of AEs graded according to the American Society for Gastrointestinal Endoscopy lexicon. Results: A total of 60 patients (mean age, 57.2 ± 13.2; 75% women) were included, of whom 30 (50%) underwent EUS-GG-ERCP and 30 (50%) underwent e-ERCP (double-balloon enteroscope ERCP, 19; single-balloon enteroscope ERCP, 11). The technical success rate was significantly higher in the EUS-GG-ERCP versus the e-ERCP group (100% vs 60.0%, P <.001). Total procedure time was significantly shorter in patients who underwent EUS-GG-ERCP (49.8 minutes vs 90.7 minutes, P <.001). Postprocedure median length of hospitalization was shorter in the EUS-GG group (1 vs 10.5 days, P =.02). Rate of AEs was similar in both groups (10% vs 6.7%, P = 1). Conclusions: EUS-GG-ERCP may be superior to e-ERCP in patients with RYGB anatomy in terms of a higher technical success and shorter procedural times and offers a similar safety profile.

AB - Background and Aims: ERCP is challenging in patients with Roux-en-Y gastric bypass (RYGB) anatomy. EUS-guided gastrogastrostomy (GG) creation is a promising novel technique to access the excluded stomach to facilitate conventional ERCP. We aimed to compare procedural outcomes and adverse events (AEs) between EUS-guided GG-assisted ERCP (EUS-GG-ERCP) and enteroscopy-assisted ERCP (e-ERCP) in patients with RYGB. Methods: Patients with RYGB anatomy who underwent EUS-GG-ERCP or e-ERCP between 2014 and 2016 at 5 tertiary centers were included. The primary outcome was technical success of ERCP, defined as successful cannulation of the selected duct with successful intervention as intended. Secondary outcomes included total procedural time (in the EUS-GG group, total procedural time included EUS-GG creation plus ERCP procedure time), length of hospital stay, and rate/severity of AEs graded according to the American Society for Gastrointestinal Endoscopy lexicon. Results: A total of 60 patients (mean age, 57.2 ± 13.2; 75% women) were included, of whom 30 (50%) underwent EUS-GG-ERCP and 30 (50%) underwent e-ERCP (double-balloon enteroscope ERCP, 19; single-balloon enteroscope ERCP, 11). The technical success rate was significantly higher in the EUS-GG-ERCP versus the e-ERCP group (100% vs 60.0%, P <.001). Total procedure time was significantly shorter in patients who underwent EUS-GG-ERCP (49.8 minutes vs 90.7 minutes, P <.001). Postprocedure median length of hospitalization was shorter in the EUS-GG group (1 vs 10.5 days, P =.02). Rate of AEs was similar in both groups (10% vs 6.7%, P = 1). Conclusions: EUS-GG-ERCP may be superior to e-ERCP in patients with RYGB anatomy in terms of a higher technical success and shorter procedural times and offers a similar safety profile.

UR - http://www.scopus.com/inward/record.url?scp=85050154363&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050154363&partnerID=8YFLogxK

U2 - 10.1016/j.gie.2018.04.2356

DO - 10.1016/j.gie.2018.04.2356

M3 - Article

C2 - 29730228

AN - SCOPUS:85050154363

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

ER -