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DOI: 10.1055/s-0045-1805199
Early endoscopic ultrasound-directed trans-gastric ERCP (EDGE) with additional suturing achieves better safety outcomes in patients with a gastric bypass
Authors
Aims Endoscopic ultrasound-directed trans-gastric endoscopic retrograde cholangiopancreatography (EDGE, ERCP) is an effective approach in gastric bypass. However, the time interval between both procedures and the impact of lumen-apposing metal stent (LAMS) suturing is unclear. To determine the safest interval in a large cohort.
Methods This is an observational multicenter study. All patients who underwent an EDGE were included and classified depending on the time interval: one-stage,≤3d,>3-7d and≥7d. The suturing of the LAMS and LAMS-related adverse events (AEs) were assessed.
Results Two-hundred and six patients (age: 60±12,72.3% female) were included. 64.1% presented with biliary stones and 30.6% with acute cholangitis.
The most frequent technique was direct (63.6%) by gastro-gastric route (80.1%). 32% of LAMS were sutured, with a higher rate in one-stage compared to two-stages (46.3% vs. 25.2%, p=0.002). Overall, the LAMS suture was associated with a lower AE rate (6.1% vs. 16.4%, p=0.040).
The global LAMS-related AE rate was 13.1% as follows: one-stage(n=4, 6%),≤3d(n=4, 10.8%),>3-7d(n=2, 11.8%) and≥7d(n=17, 20%). All AEs in≤3d and>3-7d occurred in non-sutured LAMS. 51.9% of AEs were severe (AGREE>2). The most frequent AE was dislodgement without peritonitis (n=14, 51.9%). There were less AEs in the one-stage compared to the two-stages (6% vs. 18.2%, p=0.035). The AE rate was much higher in patients one-stage strategy when the LAMS was not sutured (8.3% vs. 3.2%, p=0.379).
The clinical success of ERCP was 94.7% in median follow-up of 9 months with a 10.2% of persistent fistula.
Conclusions LAMS suture was associated with a lower AE rate and should be preferred, particularly in patients with a one-stage and<7 days interval strategies.
Publikationsverlauf
Artikel online veröffentlicht:
27. März 2025
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