TY - JOUR
T1 - Maximizing success in single-session EUS-directed transgastric ERCP
T2 - a retrospective cohort study to identify predictive factors of stent migration
AU - Shinn, Brianna
AU - Boortalary, Tina
AU - Raijman, Isaac
AU - Nieto, Jose
AU - Khara, Harshit S.
AU - Kumar, S. Vikas
AU - Confer, Bradley
AU - Diehl, David L.
AU - El Halabi, Maan
AU - Ichkhanian, Yervant
AU - Runge, Thomas
AU - Kumbhari, Vivek
AU - Khashab, Mouen
AU - Tyberg, Amy
AU - Shahid, Haroon
AU - Sarkar, Avik
AU - Gaidhane, Monica
AU - Bareket, Romy
AU - Kahaleh, Michel
AU - Piraka, Cyrus
AU - Zuchelli, Tobias
AU - Law, Ryan
AU - Sondhi, Arjun
AU - Kedia, Prashant
AU - Robbins, Justin
AU - Calogero, Cristina
AU - Bakhit, Mena
AU - Chiang, Austin
AU - Schlachterman, Alexander
AU - Kowalski, Thomas
AU - Loren, David
N1 - Publisher Copyright:
© 2021 American Society for Gastrointestinal Endoscopy
PY - 2021/10
Y1 - 2021/10
N2 - Background and Aims: EUS-directed transgastric ERCP (the EDGE procedure) is a simplified method of performing ERCP in Roux-en-Y gastric bypass patients. The EDGE procedure involves placement of a lumen-apposing metal stent (LAMS) into the excluded stomach to serve as a conduit for passage of the duodenoscope for pancreatobiliary intervention. Originally a multistep process, urgent indications for ERCP have led to the development of single-session EDGE (SS-EDGE) with LAMS placement and ERCP performed in the same session. The goal of this study was to identify predictive factors of intraprocedural LAMS migration in SS-EDGE. Methods: We conducted a multicenter retrospective review that included 9 tertiary medical centers across the United States. Data were collected and analyzed from 128 SS-EDGE procedures. The primary outcome was intraprocedural LAMS migration. Secondary outcomes were other procedural adverse events such as bleeding and perforation. Results: Eleven LAMS migrations were observed in 128 procedures (8.6%). Univariate analysis of clinically relevant variables was performed, as was a binary logistic regression analysis of stent diameter and stent dilation. This revealed that use of a smaller (15 mm) diameter LAMS was an independent predictor of intraprocedural stent migration (odds ratio, 5.36; 95% confidence interval, 1.29-22.24; P = .021). Adverse events included 3 patients who required surgery and 2 who experienced intraprocedural bleeding. Conclusions: Use of a larger-diameter LAMS is a predictive factor for a nonmigrated stent and improved procedural success in SS-EDGE. Although larger patient cohorts are needed to adequately assess these findings, performance of LAMS dilation and fixation may also decrease risk of intraprocedural LAMS migration and improve procedural success.
AB - Background and Aims: EUS-directed transgastric ERCP (the EDGE procedure) is a simplified method of performing ERCP in Roux-en-Y gastric bypass patients. The EDGE procedure involves placement of a lumen-apposing metal stent (LAMS) into the excluded stomach to serve as a conduit for passage of the duodenoscope for pancreatobiliary intervention. Originally a multistep process, urgent indications for ERCP have led to the development of single-session EDGE (SS-EDGE) with LAMS placement and ERCP performed in the same session. The goal of this study was to identify predictive factors of intraprocedural LAMS migration in SS-EDGE. Methods: We conducted a multicenter retrospective review that included 9 tertiary medical centers across the United States. Data were collected and analyzed from 128 SS-EDGE procedures. The primary outcome was intraprocedural LAMS migration. Secondary outcomes were other procedural adverse events such as bleeding and perforation. Results: Eleven LAMS migrations were observed in 128 procedures (8.6%). Univariate analysis of clinically relevant variables was performed, as was a binary logistic regression analysis of stent diameter and stent dilation. This revealed that use of a smaller (15 mm) diameter LAMS was an independent predictor of intraprocedural stent migration (odds ratio, 5.36; 95% confidence interval, 1.29-22.24; P = .021). Adverse events included 3 patients who required surgery and 2 who experienced intraprocedural bleeding. Conclusions: Use of a larger-diameter LAMS is a predictive factor for a nonmigrated stent and improved procedural success in SS-EDGE. Although larger patient cohorts are needed to adequately assess these findings, performance of LAMS dilation and fixation may also decrease risk of intraprocedural LAMS migration and improve procedural success.
UR - http://www.scopus.com/inward/record.url?scp=85111585020&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85111585020&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2021.04.022
DO - 10.1016/j.gie.2021.04.022
M3 - Article
C2 - 33957105
AN - SCOPUS:85111585020
SN - 0016-5107
VL - 94
SP - 727
EP - 732
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 4
ER -