Tyberg Amy, Nieto Jose, Salgado Sanjay, Weaver Kristen, Kedia Prashant, Sharaiha Reem Z, Gaidhane Monica, Kahaleh Michel
Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, NY, USA.
Division of Gastroenterology and Hepatology, Borland-Groover Clinic (BGC), Jacksonville, FL, USA.
Clin Endosc. 2017 Mar;50(2):185-190. doi: 10.5946/ce.2016.030. Epub 2016 Sep 19.
BACKGROUND/AIMS: Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Rouxen-Y gastric bypass (RYGB) is challenging. Standard ERCP and enteroscopy-assisted ERCP are associated with limited success rates. Laparoscopy- or laparotomy-assisted ERCP yields improved efficacy rates, but with higher complication rates and costs. We present the first multicenter experience regarding the efficacy and safety of endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) or EUS.
All patients who underwent EDGE at two academic centers were included. Clinical success was defined as successful ERCP and/or EUS through the use of lumen-apposing metal stents (LAMS). Adverse events related to EDGE were separated from ERCP- or EUS-related complications and were defined as bleeding, stent migration, perforation, and infection.
Sixteen patients were included in the study. Technical success was 100%. Clinical success was 90% (=10); five patients were awaiting maturation of the fistula tract prior to ERCP or EUS, and one patient had an aborted ERCP due to perforation. One perforation occurred, which was managed endoscopically. Three patients experienced stent dislodgement; all stents were successfully repositioned or bridged with a second stent. Ten patients (62.5%) had their LAMS removed. The average weight change from LAMS insertion to removal was negative 2.85 kg.
EDGE is an effective, minimally invasive, single-team solution to the difficulties associated with ERCP in patients with RYGB.
背景/目的：在接受 Roux-en-Y 胃旁路术（RYGB）的患者中进行内镜逆行胰胆管造影术（ERCP）具有挑战性。标准 ERCP 和肠镜辅助 ERCP 的成功率有限。腹腔镜或剖腹手术辅助 ERCP 的疗效有所提高，但并发症发生率更高且成本更高。我们展示了关于内镜超声（EUS）引导下经胃 ERCP（EDGE）或 EUS 的疗效和安全性的首个多中心经验。
纳入在两个学术中心接受 EDGE 的所有患者。临床成功定义为通过使用管腔对接金属支架（LAMS）成功进行 ERCP 和/或 EUS。与 EDGE 相关的不良事件与 ERCP 或 EUS 相关并发症分开定义，包括出血、支架移位、穿孔和感染。
16 名患者纳入研究。技术成功率为 100%。临床成功率为 90%（=10）；5 名患者在进行 ERCP 或 EUS 之前等待瘘管成熟，1 名患者因穿孔中止 ERCP。发生 1 例穿孔，通过内镜处理。3 名患者出现支架移位；所有支架均成功重新定位或用第二个支架桥接。10 名患者（62.5%）取出了 LAMS。从插入 LAMS 到取出的平均体重变化为负 2.85 千克。
EDGE 是一种有效、微创、单团队解决 RYGB 患者 ERCP 相关困难的方法。
