CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(02): E163-E171
DOI: 10.1055/a-1067-4411
Original article
Owner and Copyright © Georg Thieme Verlag KG 2020

EDGE in Roux-en-Y gastric bypass: How does it compare to laparoscopy-assisted and balloon enteroscopy ERCP: a systematic review and meta-analysis

Banreet Singh Dhindsa
1   University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, United States
,
Amaninder Dhaliwal
2   Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Babu P. Mohan
3   Banner University Medical Center, University of Arizona, Tucson, Arizona, United States
,
Harmeet Singh Mashiana
2   Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Mohit Girotra
4   Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, Florida, United States
,
Shailender Singh
2   Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Gordon Ohning
5   Division of Gastroenterology, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, United States
,
Ishfaq Bhat
2   Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Douglas G. Adler
6   Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah
› Author Affiliations
Further Information

Publication History

submitted 30 July 2019

accepted after revision 15 October 2019

Publication Date:
22 January 2020 (online)

Abstract

Background and study aims Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a new endoscopic procedure to perform ERCP in Roux-en-y gastric bypass (RYGB) patients. The aim of this study was to conduct a systematic review and meta-analysis to evaluate technical success, clinical success and adverse effects of EDGE and compare it to laparoscopic ERCP (LA-ERCP) and balloon ERCP (BE-ERCP).

Patients and methods We conducted a comprehensive search of several databases and conference proceedings including PubMed, EMBASE, Google-Scholar, LILACS, SCOPUS, and Web of Science databases to identify studies reporting on EDGE, LA-ERCP, and BE-ERCP. The primary outcome was to evaluate technical and clinical success of all three procedures and the secondary analysis focused on calculating the pooled rate of all adverse events (AEs), along with the commonly reported AE subtypes.

Results Twenty-four studies on 1268 patients were included in our analysis with the majority of the population being males with mean age 53.72 years. Pooled rates of technical and clinical success with EDGE wer 95.5 % and 95.9 %, with LA-ERCP were 95.3 % and 92.9 % and were BE-ERCP were 71.4 % and 58.7 %, respectively. Pooled rates of all AEs with EDGE were 21.9 %, with LA-ERCP 17.4 % and with BE-ERCP 8.4 %. Stent migration was the most common AE with EDGE with 13.3 % followed by bleeding with 6.6 %.

Conclusion Our meta-analysis demonstrated that the technical and clinical success of EDGE procedure is better than BE-ERCP and comparable to that of LA-ERCP in RYGB patients. EDGE also has a similar safety profile as compared to LA-ERCP but has higher AE rate as compared to BE-ERCP.

Supplementary material

 
  • References

  • 1 Ogden CL, Carroll MD, Kit BK. et al. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 2014; 311: 806-814
  • 2 Mechanick JI, Youdim A, Jones DB. et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient -- 2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity 2013; 21 (Suppl. 01) S1-27
  • 3 Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg 2013; 23: 427-436
  • 4 Angrisani L, Santonicola A, Iovino P. et al. IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. Obes Surg 2018; 28: 3783-3794
  • 5 Byrne TK. Complications of surgery for obesity. Surg Clin North Am 2001; 81: 1181-1193, vii-viii
  • 6 Villegas L, Schneider B, Provost D. et al. Is routine cholecystectomy required during laparoscopic gastric bypass?. Obes Surg 2004; 14: 206-211
  • 7 Calle EE, Rodriguez C, Walker-Thurmond K. et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003; 348: 1625-1638
  • 8 Wang TJ, Ryou M. Evolving techniques for endoscopic retrograde cholangiopancreatography in gastric bypass patients. Curr Opin Gastroenterol 2018; 34: 444-450
  • 9 Ross AS. Techniques for performing ERCP in Roux-en-Y gastric bypass patients. Gastroenterol Hepatol (NY) 2012; 8: 390-392
  • 10 da Ponte-Neto AM, Bernardo WM, de Coutinho ALM. et al. Comparison between enteroscopy-based and laparoscopy-assisted ERCP for accessing the biliary tree in patients with roux-en-y gastric bypass: systematic review and meta-analysis. Obes Surg 2018; 28: 4064-4076
  • 11 Abbas AM, Strong AT, Diehl DL. et al. Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass. Gastrointest Endosc 2018; 87: 1031-1039
  • 12 Banerjee N, Parepally M, Byrne TK. et al. Systematic review of transgastric ERCP in Roux-en-Y gastric bypass patients. Surg Obes Relat Dis 2017; 13: 1236-1242
  • 13 Kedia P, Sharaiha RZ, Kumta NA. et al. Internal EUS-directed transgastric ERCP (EDGE): game over. Gastroenterology 2014; 147: 566-568
  • 14 Bukhari M, Kowalski T, Nieto J. et al. An international, multicenter, comparative trial of EUS-guided gastrogastrostomy-assisted ERCP versus enteroscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Gastrointest Endosc 2018; 88: 486-494
  • 15 Chiang AL, Gaidhane M, Loren DE. et al. 338 Impact of EUS-directed transgastric ercp (edge procedure) access route on technical success and adverse events: a multi-center experience. Gastrointest Endosc 2018; 87: AB70-AB71
  • 16 James TW, Baron TH. Endoscopic ultrasound-directed transgastric ERCP (EDGE): a single-center us experience with follow-up data on fistula closure. Obes Surg 2019; 29: 451-456
  • 17 Wang TJ, Thompson CC, Ryou M. Gastric access temporary for endoscopy (GATE): a proposed algorithm for EUS-directed transgastric ERCP in gastric bypass patients. Surg Endosc 2019; 33: 2024-2033
  • 18 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151: 264-269
  • 19 Stroup DF, Berlin JA, Morton SC. et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283: 2008-2012
  • 20 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603-605
  • 21 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
  • 22 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
  • 23 Sutton AJ, Abrams KR, Jones DR. et al. Methods for meta-analysis in medical research. Wiley Chichester; 2000
  • 24 Higgins JPT, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
  • 25 Kanwal F, White D. Systematic reviews and meta-analyses in clinical gastroenterology and hepatology. Clin Gastroenterol Hepat 2012; 10: 1184-1186
  • 26 Guyatt GH, Oxman AD, Kunz R. et al. GRADE guidelines: 7. Rating the quality of evidence–inconsistency. J Clin Epidem 2011; 64: 1294-1302
  • 27 Easterbrook PJ, Gopalan R, Berlin JA. et al. Publication bias in clinical research. Lancet 1991; 337: 867-872
  • 28 Duval S, Tweedie R. Trim and fill: a simple funnel‐plot–based method of testing and adjusting for publication bias in meta‐analysis. Biometrics 2000; 56: 455-463
  • 29 Rothstein HR, Sutton AJ, Borenstein M. Publication bias in meta-analysis: Prevention, Assessment and Adjustments. Wiley; 2005
  • 30 Irani S, Yang J, Khashab MA. Mitigating lumen-apposing metal stent dislodgment and allowing safe, single-stage EUS-directed transgastric ERCP. VideoGIE 2018; 3: 322-324
  • 31 Kedia P, Kumta NA, Sharaiha R. et al. Bypassing the bypass: EUS-directed transgastric ERCP for Roux-en-Y anatomy. Gastrointest Endosc 2015; 81: 223-224
  • 32 Tyberg A, Nieto J, Salgado S. et al. Endoscopic ultrasound (EUS)-directed transgastric endoscopic retrograde cholangiopancreatography or EUS: mid-term analysis of an emerging procedure. Clin Endosc 2017; 50: 185-190
  • 33 Kedia P, Tarnasky PR, Nieto J. et al. EUS-directed transgastric ERCP (EDGE) versus laparoscopy-assisted ERCP (LA-ERCP) for Roux-en-Y gastric bypass (RYGB) anatomy: a multicenter early comparative experience of clinical outcomes. J Clin Gastroenterol 2019; 53: 304-308
  • 34 Ngamruengphong S, Nieto J, Kunda R. et al. Endoscopic ultrasound-guided creation of a transgastric fistula for the management of hepatobiliary disease in patients with Roux-en-Y gastric bypass. Endoscopy 2017; 49: 549-552
  • 35 Bukhari M, Kowalski T, Nieto J. et al. An international, multicenter, comparative trial of EUS-guided gastrogastrostomy-assisted ERCP versus enteroscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Gastrointest Endosc 2018; 88: 486-494
  • 36 Bertin PM, Singh K, Arregui ME. Laparoscopic transgastric endoscopic retrograde cholangiopancreatography (ERCP) after gastric bypass: case series and a description of technique. Surg Endosc 2011; 25: 2592-2596
  • 37 Bowman E, Greenberg J, Garren M. et al. Laparoscopic-assisted ERCP and EUS in patients with prior Roux-en-Y gastric bypass surgery: a dual-center case series experience. Surg Endosc 2016; 30: 4647-4652
  • 38 May DD, Parker DM, Vogels ED. et al. Outcomes of laparoscopic-assisted ERCP after Roux-En-Y gastric bypass: safe and effective for management of sphincter of Oddi dysfunction. Endosc Int Open 2019; 7: E1276-E1280
  • 39 Falcao M, Campos JM, Galvao Neto M. et al. Transgastric endoscopic retrograde cholangiopancreatography for the management of biliary tract disease after Roux-en-Y gastric bypass treatment for obesity. Obes Surg 2012; 22: 872-876
  • 40 Farukhi MCB, Davis B. et al. Treatment of biliary disease with transgastric ERCP after Roux-En-Y gastric bypass. Surg Endosc 2016; S325-500
  • 41 Frederiksen NA, Tveskov L, Helgstrand F. et al. Treatment of common bile duct stones in gastric bypass patients with laparoscopic transgastric endoscopic retrograde cholangiopancreatography. Obes Surg 2017; 27: 1409-1413
  • 42 Grimes KL, Maciel VH, Mata W. et al. Complications of laparoscopic transgastric ERCP in patients with Roux-en-Y gastric bypass. Surg Endosc 2015; 29: 1753-1759
  • 43 Habenicht Yancey K, McCormack LK, McNatt SS. et al. Laparoscopic-assisted transgastric ERCP: a single-institution experience. J Obes 2018; 2018: 8275965
  • 44 Kumar U, Kroner PT, Jovanovic I. et al. Balloon-overtube enteroscopy assisted (BAE) versus laparoscopy-assisted ERCP in Bariatric Post-Roux-en-Y gastric bypass patients: a comparative study. Gastrointest Endosc 2016; 83: AB298
  • 45 Lin C, Aragon RJ, Carr AD. et al. Direct access ERCP: a novel and reliable surgical technique for patients with Roux-en-Y anatomy. Surg Endosc 2014; 28: 311
  • 46 Mejia R, Achurra P, Gabrielli M. et al. Laparoscopy-assisted trans-gastric rendez-vous for the treatment of common bile duct stones in patients with prior Roux-en-Y gastric bypass. Obes Surg 2016; 26: 2809-2813
  • 47 Paranandi B, Joshi D, Mohammadi B. et al. Laparoscopy-assisted ERCP (LA-ERCP) following bariatric gastric bypass surgery: initial experience of a single UK centre. Frontline Gastroenterol 2016; 7: 54-59
  • 48 Saleem A, Levy MJ, Petersen BT. et al. Laparoscopic assisted ERCP in Roux-en-Y gastric bypass (RYGB) surgery patients. J Gastrointest Surg 2012; 16: 203-208
  • 49 Schreiner MA, Chang L, Gluck M. et al. Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP in bariatric post-Roux-en-Y gastric bypass patients. Gastrointest Endosc 2012; 75: 748-756
  • 50 Snauwaert C, Laukens P, Dillemans B. et al. Laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography in bariatric Roux-en-Y gastric bypass patients. Endosc Int Open 2015; 3: E458-E463
  • 51 Sun Z, Rodriguez J, Albeldawi M. et al. Laparoscopic transgastric endoscopic retrograde cholangiopancreatography for the treatment of biliary tract disease after Roux-en-Y gastric bypass. J Am Coll Surg 2014; 219: e60-e61
  • 52 Choi EK, Chiorean MV, Cote GA. et al. ERCP via gastrostomy vs. double balloon enteroscopy in patients with prior bariatric Roux-en-Y gastric bypass surgery. Surg Endosc 2013; 27: 2894-2899
  • 53 Kashani A, Abboud G, Lo SK. et al. Double balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in Roux-en-Y gastric bypass anatomy: expert vs. novice experience. Endosc Int Open 2018; 6: E885-E891
  • 54 Mohan BP, Adler DG. Heterogeneity in systematic review and meta-analysis: how to read between the numbers. Gastrointest Endosc 2019; 89: 902-903