Endoscopy 2025; 57(S 02): S55-S56
DOI: 10.1055/s-0045-1805199
Abstracts | ESGE Days 2025
Oral presentation
EUS-guided anastomosis: let's get connected 03/04/2025, 14:30 – 15:30 Room 120+121

Early endoscopic ultrasound-directed trans-gastric ERCP (EDGE) with additional suturing achieves better safety outcomes in patients with a gastric bypass

Authors

  • E Perez-Cuadrado-Robles

    1   European Hospital Georges Pompidou, Paris, France
  • A Tyberg

    2   Hackensack Meridian Health Care Syste, New Jersey, United States of America
  • L Monino

    3   Hospital Center Universitaire Hospital Saint Eloi, Montpellier, France
  • S Godat

    4   Lausanne University Hospital, Lausanne, Switzerland
  • F Caillol

    5   Institute Paoli-Calmettes, Marseille, France
  • A Sarkar

    6   Hackensack Meridian Health Care System, New Jersey, United States of America
  • L Rebibo

    1   European Hospital Georges Pompidou, Paris, France
  • M Dalex

    4   Lausanne University Hospital, Lausanne, Switzerland
  • M Schaefer

    7   CHRU de Nancy – Hôpitaux de Brabois, NANCY, France
  • J Jacques

    8   CHU Dupuytren 1, Limoges, France
  • A Iman

    6   Hackensack Meridian Health Care System, New Jersey, United States of America
  • E Tenorio Gonzalez

    1   European Hospital Georges Pompidou, Paris, France
  • J P Ratone

    5   Institute Paoli-Calmettes, Marseille, France
  • A Jeremie

    8   CHU Dupuytren 1, Limoges, France
  • S Haroon

    6   Hackensack Meridian Health Care System, New Jersey, United States of America
  • H Le Bourhis

    1   European Hospital Georges Pompidou, Paris, France
  • P H Deprez

    9   Department of Gastroenterolofgy and Hepatology, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium
  • C Cellier

    1   European Hospital Georges Pompidou, Paris, France
  • T Moreels

    10   Cliniques universitaires Saint-Luc (UCLouvain), Brussels, Belgium
  • M Kahaleh

    11   Foundation for Interventional ' Therapeutic Endoscopy, New Jersey, United States of America
 

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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