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Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography for patients with Roux-en-Y gastric bypass anatomy: technical overview
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Hirokazu Honda, Jeffrey D. Mosko, Ryosuke Kobayashi, Andras Fecso, Bong Sik Kim, Schoeman Scott, Gary R. May
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Clin Endosc 2022;55(6):736-741. Published online October 5, 2022
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DOI: https://doi.org/10.5946/ce.2022.114
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 Abstract
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- Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass anatomy is a well-documented challenge. Traditionally, this problem has been overcome with adjunctive techniques, such as device-assisted ERCP, including double-balloon or single-balloon enteroscopy and laparoscopy-assisted transgastric ERCP. Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a novel technique that enables access to the ampulla using a duodenoscope without surgical intervention and has shown high clinical and technical success rates in recent studies. However, this approach is technically demanding, necessitating a thorough understanding of the gastrointestinal anatomy as well as high operator experience. In this review, we provide a technical overview of EDGE in parallel with our personal experience at our center and propose a simple algorithm to select patients for its appropriate application. In conjunction, the outcomes of EDGE compared with those of device-assisted and laparoscopy-assisted transgastric ERCP will be discussed.
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Citations
Citations to this article as recorded by  - Interventional Endoscopic Ultrasonography: Advances in Application
Haidar Khan, Sharon Slomovich, Neal C. Shah, Frank Gress
Journal of Clinical Medicine.2025; 14(10): 3286. CrossRef - Surgical Palliation for Pancreatic Cancer
Adriana C. Gamboa, Rebecca A. Snyder
Surgical Oncology Clinics of North America.2025;[Epub] CrossRef - Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography procedure for choledocholithiasis after sleeve gastrectomy and Roux-en-Y
Reid D. Wasserman, Varun Kesar, Vivek Kesar, Paul Yeaton, Shehriyar Mehershahi
Endoscopy.2024; 56(S 01): E390. CrossRef - Complications of Post-Roux-en-Y Gastric Bypass: A Case of Excluded Stomach Perforation
C. Ryan Williams, Nathaniel Grabill, Mena Louis, Deepak Dev Vivekanandan, Timothy Stevens
Cureus.2024;[Epub] CrossRef - A novel endoscopic ultrasound-guided transluminal anchor device
Abhishek Agnihotri, Alexander Schlachterman
Endoscopy.2023; 55(S 01): E775. CrossRef
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