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Endoscopic Ultrasound (EUS)-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography or EUS: Mid-Term Analysis of an Emerging Procedure
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Amy Tyberg, Jose Nieto, Sanjay Salgado, Kristen Weaver, Prashant Kedia, Reem Z. Sharaiha, Monica Gaidhane, Michel Kahaleh
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Clin Endosc 2017;50(2):185-190. Published online September 19, 2016
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DOI: https://doi.org/10.5946/ce.2016.030
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Abstract
PDFPubReaderePub
- Background
/Aims: Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Rouxen-Y gastric bypass (RYGB) is challenging. Standard ERCP and enteroscopy-assisted ERCP are associated with limited success rates. Laparoscopy- or laparotomy-assisted ERCP yields improved efficacy rates, but with higher complication rates and costs. We present the first multicenter experience regarding the efficacy and safety of endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) or EUS.
Methods All patients who underwent EDGE at two academic centers were included. Clinical success was defined as successful ERCP and/or EUS through the use of lumen-apposing metal stents (LAMS). Adverse events related to EDGE were separated from ERCP- or EUS-related complications and were defined as bleeding, stent migration, perforation, and infection.
Results Sixteen patients were included in the study. Technical success was 100%. Clinical success was 90% (n=10); five patients were awaiting maturation of the fistula tract prior to ERCP or EUS, and one patient had an aborted ERCP due to perforation. One perforation occurred, which was managed endoscopically. Three patients experienced stent dislodgement; all stents were successfully repositioned or bridged with a second stent. Ten patients (62.5%) had their LAMS removed. The average weight change from LAMS insertion to removal was negative 2.85 kg.
Conclusions EDGE is an effective, minimally invasive, single-team solution to the difficulties associated with ERCP in patients with RYGB.
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Peroral Endoscopic Myotomy: Establishing a New Program
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Nikhil A. Kumta, Shivani Mehta, Prashant Kedia, Kristen Weaver, Reem Z. Sharaiha, Norio Fukami, Hitomi Minami, Fernando Casas, Monica Gaidhane, Arnon Lambroza, Michel Kahaleh
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Clin Endosc 2014;47(5):389-397. Published online September 30, 2014
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DOI: https://doi.org/10.5946/ce.2014.47.5.389
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Abstract
PDFPubReaderePub
Achalasia is an esophageal motility disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES) and aperistalsis of the esophageal body. Treatment of achalasia is aimed at decreasing the resting pressure in the LES. Peroral endoscopic myotomy (POEM), derived from natural orifice transluminal endoscopic surgery (NOTES) and advances in endoscopic submucosal dissection (ESD), presents a novel, minimally invasive, and curative endoscopic treatment for achalasia. POEM involves an esophageal mucosal incision followed by creation of a submucosal tunnel crossing the esophagogastric junction and myotomy before closure of the mucosal incision. Although the procedure is technically demanding and requires a certain degree of skill and competency, treatment success is high (90%) with low complication rates. Since the first described POEM in humans in 2010, it has been used increasingly at centers worldwide. This article reviews available published clinical studies demonstrating POEM efficacy and safety in order to present a proposal on how to establish a dedicated POEM program and reach base proficiency for the procedure.
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Ioana Smith, Michel Kahaleh Journal of Clinical Gastroenterology.2018; 52(4): 277. CrossRef - Treatment of Achalasia with Per-Oral Endoscopic Myotomy: Analysis of 50 Consecutive Patients
Erica D. Kane, David J. Desilets, Donna Wilson, Marc Leduc, Vikram Budhraja, John R. Romanelli Journal of Laparoendoscopic & Advanced Surgical Techniques.2018; 28(5): 514. CrossRef - Per-oral endoscopic myotomy (with video)
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Robert Bechara, Haruhiro Inoue Gastrointestinal Endoscopy Clinics of North America.2016; 26(2): 237. CrossRef - Optical coherence tomography (OCT) prior to peroral endoscopic myotomy (POEM) reduces procedural time and bleeding: a multicenter international collaborative study
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United European Gastroenterology Journal.2016; 4(5_suppl): A157. CrossRef - Idiopathic (primary) achalasia: a review
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Robert Bechara, Haruo Ikeda, Haruhiro Inoue Nature Reviews Gastroenterology & Hepatology.2015; 12(7): 410. CrossRef
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