Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, USA.
Division of Gastroenterology, North Shore-LIJ, Forest Hills Hospital, New York, USA.
Endoscopy. 2015 Feb;47(2):159-63. doi: 10.1055/s-0034-1390771. Epub 2015 Jan 9.
Patients with Roux-en-Y gastric bypass (RYGB) anatomy pose challenges when endoscopic retrograde cholangiopancreatography (ERCP) is required. Deep enteroscopy-assisted ERCP can allow pancreaticobiliary intervention in these patients, but with limited success. This case series describes endoscopic ultrasound-directed transgastric ERCP (EDGE) for patients following RYGB.
Patients with RYGB anatomy undergoing EDGE at a tertiary care center were included in this prospective single-arm feasibility study. All procedures were performed in two stages. First a 16-Fr percutaneous endoscopic gastrostomy (PEG) was placed in the excluded stomach using endoscopic ultrasound (EUS) guidance. Second, ERCP was performed through the newly fashioned gastrostomy and a transcutaneous fully covered metal esophageal stent.
Six patients (5 women, 1 man) with RYGB anatomy underwent EDGE. EUS-guided PEG placement was successful in all six patients (100 %). Antegrade ERCP was successful in all six patients (100 %) with the stages being separated by a mean of 5.8 days. The mean procedure times for the two stages were 81 minutes and 98 minutes. Two patients (33 %) had localized PEG site infections that were managed with oral antibiotics. There were no adverse events related to ERCP.
EDGE is both feasible and safe to perform in RYGB patients. Given the high success rates of our recent experience, we suspect that this technique can be performed as a one-stage procedure to provide a cost-effective, minimally invasive option for a common problem in a growing patient population.
当需要进行内镜逆行胰胆管造影术（ERCP）时， Roux-en-Y 胃旁路（RYGB）解剖结构的患者会带来挑战。通过深度结肠镜辅助 ERCP 可以对这些患者进行胰胆介入治疗，但成功率有限。本病例系列描述了经胃超声内镜引导下经胃 ERCP（EDGE）在 RYGB 后的患者中的应用。
本前瞻性单臂可行性研究纳入了在三级保健中心接受 EDGE 的 RYGB 解剖结构患者。所有手术均分两阶段进行。首先，在超声内镜（EUS）引导下将 16Fr 经皮内镜胃造口术（PEG）置于排除的胃中。其次，通过新形成的胃造口和经皮完全覆盖的金属食管支架进行 ERCP。
6 例 RYGB 解剖结构患者接受了 EDGE。在所有 6 例患者（100%）中，EUS 引导下 PEG 放置均成功。在所有 6 例患者（100%）中，顺行 ERCP 均成功，两阶段之间的间隔平均为 5.8 天。两个阶段的平均手术时间分别为 81 分钟和 98 分钟。2 例患者（33%）发生局部 PEG 部位感染，经口服抗生素治疗。与 ERCP 相关的无不良事件。
EDGE 在 RYGB 患者中既可行又安全。鉴于我们最近的经验成功率较高，我们怀疑该技术可以作为一个阶段的手术进行，为不断增长的患者群体中的常见问题提供一种具有成本效益、微创的选择。
