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KMID : 1038120220550060736
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Clinical Endoscopy
2022 Volume.55 No. 6 p.736 ~ p.741
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Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography for patients with Roux-en-Y gastric bypass anatomy: technical overview
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Honda Hirokazu
Mosko Jeffrey D.
May Gary R.
Scott Schoeman
Kim Bong-Sik
Fecso Andras
Kobayashi Ryosuke
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Abstract
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Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass anatomy is a well-documented challenge. Traditionally, this problem has been overcome with adjunctive techniques, such as device-assisted ERCP, including double-balloon or single-balloon enteroscopy and laparoscopy-assisted transgastric ERCP. Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a novel technique that enables access to the ampulla using a duodenoscope without surgical intervention and has shown high clinical and technical success rates in recent studies. However, this approach is technically demanding, necessitating a thorough understanding of the gastrointestinal anatomy as well as high operator experience. In this review, we provide a technical overview of EDGE in parallel with our personal experience at our center and propose a simple algorithm to select patients for its appropriate application. In conjunction, the outcomes of EDGE compared with those of device-assisted and laparoscopy-assisted transgastric ERCP will be discussed.
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KEYWORD
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Endoscopic retrograde cholangiopancreatography, Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography, Gastric bypass
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