Project description:Background and aimsAccessing the pancreatobiliary region in patients with a history of Roux-en-Y gastric bypass (RYGB) can be challenging. Traditionally, techniques such as percutaneous biliary drainage, enteroscopy-assisted ERCP, and laparoscopy-assisted ERCP have been used. However, each technique has its limitations. EUS-directed transgastric ERCP (EDGE) using a lumen-apposing metal stent (LAMS) has emerged as a novel endoscopic technique for ERCP in patients who have undergone RYGB. The aim of this case series was to highlight LAMS-related shortcomings and adverse events during the periprocedural period.MethodsThis was a retrospective review of 4 patients with RYGB anatomy who underwent EDGE for the management of pancreaticobiliary disease and experienced LAMS-related adverse events. Techniques for managing and avoiding these events are discussed.ResultsFour patients underwent EDGE with both technical and clinical success. Slight LAMS migration with partial mucosal overgrowth was encountered in 1 case and was managed by LAMS removal. A large, bleeding, distal marginal ulcer after the EDGE procedure was encountered in the second case and was managed with proton pump inhibitor and removal of the LAMS, with fistula treatment with argon plasma coagulation used to enhance closure. The third case was complicated by moderate intraprocedural bleeding after LAMS dilation, which was managed by applying balloon tamponade and placing a through-the-scope esophageal stent across the LAMS. Last, preferential food passage to the excluded stomach was noted in the fourth case and resulted in symptomatic distention. The symptomatic distention was managed by another de novo jejunogastrostomy using a LAMS for drainage.ConclusionsDespite its feasibility and acceptable safety profile, the use of LAMSs during EDGE could be associated with several procedure-specific adverse events, which can be avoided or managed endoscopically with no further consequence.

| S-EPMC7276935 | biostudies-literature

The use of a rescue stent in the management of lumen-apposing metal stent migration during EUS-directed transgastric ERCP with stent-in-stent technique to remove a forgotten metal biliary stent.

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Gastric overtube use to prevent duodenoscope loop formation during EUS-directed transgastric ERCP procedure.

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EUS-directed transgastric ERCP in Roux-en-Y gastric bypass revision of sleeve gastrectomy.

Project description:Video 1EUS-directed transgastric ERCP in Roux-en-Y gastric bypass revision of sleeve gastrectomy.

| S-EPMC9264139 | biostudies-literature

Natural orifice transendoscopic surgery as a rescue for a dislodged lumen-apposing metal stent in the peritoneum after successful EUS-directed transgastric ERCP.

Project description:Video 1Natural orifice transendoscopic surgery as a rescue for a dislodged lumen-apposing metal stent after EUS-directed transgastric ERCP.

| S-EPMC10422130 | biostudies-literature

EUS-directed transgastric ERCP (EDGE) with use of a 20-mm × 10-mm lumen-apposing metal stent in a patient with Roux-en-Y gastric bypass.

Project description: Not available

| S-EPMC6119346 | biostudies-literature

Single-session EUS-guided transgastric ERCP in the gastric bypass patient.

Project description: Not available

| S-EPMC5038594 | biostudies-literature