EUS-DIRECTED TRANSGASTRIC ERCP (EDGE) VERSUS LAPAROSCOPY-ASSISTED ERCP (LA-ERCP) IN PATIENTS WITH ROUX-EN-Y GASTRIC BYPASS (RYGB): A SYSTEMATIC REVIEW AND META-ANALYSIS

Aims Performing ERCP is challenging in patients with RYGB and it is not well defined which is the best approach. Although EDGE is arising as a new technique with promising and similar outcomes compared to LA-ERCP, better quality of evidence about this question is still required.

Methods We searched on electronic databases (PUBMED and EMBASE) through November 2021 to identify studies comparing EDGE and LA-ERCP techniques. Outcomes measured were technical success, adverse and severe adverse events, length of hospitalization and procedure time. Patient baseline characteristics and descriptive data related to EDGE procedure were also extracted.

Results A total of 5 studies, all retrospective cohorts were included, representing a sample of 268 patients. There was no significative difference between the groups in technical success, adverse events and severe adverse events. The length of hospitalization was shorter in the EDGE group (MD=-1.2 days : 95% CI – 1.86 to – 0.53; I²=47%; p=0.0004) as well as the procedure time (MD=98.62 min: 95% CI – 113.62 to – 83.63; I²=16%; p<0.00001). Descriptive data in the EDGE group demonstrated fistula closure in most patients (85%), usually through some endoscopic method, and no average weight gain was reported (n=90).

Conclusions EDGE and LA-ERCP are both adequate techniques to perform ERCP in RYGB patients, with comparable high success rates and low adverse events. However, EDGE is a less invasive technique with shorter length of hospitalization and procedure time and may be a valid option in some cases.

Publication History

Article published online:
14 April 2022