Antonini Filippo, Rizzo Giacomo Emanuele Maria, Vanella Giuseppe, Fuccio Lorenzo, Lisotti Andrea, Bronswijk Michiel, Pérez-Cuadrado-Robles Enrique, Binda Cecilia, Mazza Stefano, Anderloni Andrea, Fabbri Carlo, Tarantino Ilaria
Gastroenterology and Interventional Endoscopy Unit, Mazzoni Hospital AST Ascoli Piceno, 63100 Ascoli Piceno, Italy.
Gastroenterology and Endoscopy Unit, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, IRCCS-ISMETT, 90127 Palermo, Italy.
J Clin Med. 2025 Aug 11;14(16):5675. doi: 10.3390/jcm14165675.
Patients with Roux-en-Y gastric bypass (RYGB) are a significant challenge for endoscopic retrograde cholangiopancreatography (ERCP) due to the altered anatomy. Endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) has emerged as a valuable alternative to standard methods like enteroscopy-assisted (EA-ERCP) and laparoscopy-assisted (LA-ERCP) ERCP. EDGE involves creating a temporary fistula between the gastric pouch and the excluded stomach under EUS guidance, typically using a lumen-apposing metal stent (LAMS). This allows a standard ERCP scope to access the second duodenum and the biliary tree with standard devices. Several studies have investigated the efficacy and safety of this approach, with variations in techniques such as suturing the LAMS to prevent migration. EDGE has demonstrated high technical success rates, and current evidence indicates that it can be performed safely, with acceptable rates of adverse events such as stent migration, bleeding, and perforation, making it the preferred option in referral centers. This comprehensive review aims to provide a concise evaluation of EDGE, its techniques, outcomes, and role in managing biliary and pancreatic disorders in RYGB patients.
由于解剖结构改变，接受Roux-en-Y胃旁路术（RYGB）的患者在内镜逆行胰胆管造影术（ERCP）中是一项重大挑战。内镜超声（EUS）引导下的经胃ERCP（EDGE）已成为诸如肠镜辅助（EA-ERCP）和腹腔镜辅助（LA-ERCP）ERCP等标准方法的一种有价值的替代方法。EDGE包括在EUS引导下在胃囊和旷置胃之间建立一个临时瘘管，通常使用管腔对合金属支架（LAMS）。这使得标准的ERCP内镜能够通过标准设备进入十二指肠第二段和胆管树。多项研究调查了这种方法的有效性和安全性，在诸如缝合LAMS以防止移位等技术方面存在差异。EDGE已显示出较高的技术成功率，目前的证据表明它可以安全地进行，支架移位、出血和穿孔等不良事件发生率可接受，这使其成为转诊中心的首选方案。这篇综述旨在对EDGE、其技术、结果以及在管理RYGB患者的胆胰疾病中的作用进行简要评估。
