EUS-directed transenteric ERCP in non–Roux-en-Y gastric bypass surgical anatomy patients (with video)

Yervant Ichkhanian, Juliana Yang, Theodore W. James, Todd H. Baron, Shayan Irani, John Nasr, Reem Z. Sharaiha, Ryan Law, Andreas Wannhoff, Mouen A. Khashab

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Abstract

Background and Aims: Enteroscopy-assisted ERCP is challenging in patients with surgically altered upper GI anatomy. This study evaluated a novel procedure, EUS-directed transenteric ERCP (EDEE), in the de novo creation of an enteroenteric anastomosis for the performance of ERCP in non–Roux-en Y gastric bypass (RYGB) patients. Methods: This was a multicenter retrospective study involving 7 centers between January 2014 and October 2018. Primary outcome was clinical success (completion of EDEE and ERCP with intended interventions), and secondary outcomes were technical success and rate/severity of adverse events. Results: Eighteen patients (mean age, 63 years; 13 women) were included. The most common type of surgical anatomy was Whipple (10/18) and Roux-en-Y hepaticojejunostomy (6/18). Technical success rate of EUS-guided lumen-apposing metal stent (LAMS) placement was 100% and of ERCP was 94.44% (17/18). Fourteen patients underwent separate-session EDEE with a median of 21 days (interquartile range [IQR], 11.5-36) between the 2 procedures. Median total procedure time was 111 minutes (IQR, 81-192). Clinical success and adverse events occurred in 17 (94.4%) and 1 (5.6%; abdominal pain) patients, respectively, during a median follow-up of 88 days (IQR, 54-142). Conclusions: This study suggests that EDEE using LAMSs is feasible and safe in patients with non-RYGB surgical anatomy and complex pancreaticobiliary pathologies.

Original languageEnglish (US)
Pages (from-to)1188-1194.e2
JournalGastrointestinal endoscopy
Volume91
Issue number5
DOIs
StatePublished - May 2020

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ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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Ichkhanian, Y., Yang, J., James, T. W., Baron, T. H., Irani, S., Nasr, J., Sharaiha, R. Z., Law, R., Wannhoff, A., & Khashab, M. A. (2020). EUS-directed transenteric ERCP in non–Roux-en-Y gastric bypass surgical anatomy patients (with video). Gastrointestinal endoscopy, 91(5), 1188-1194.e2. https://doi.org/10.1016/j.gie.2019.12.043