Maximizing success in single-session EUS-directed transgastric ERCP: a retrospective cohort study to identify predictive factors of stent migration.
Publication/Presentation Date
10-1-2021
Abstract
BACKGROUND AND AIMS: EUS-directed transgastric ERCP (the EDGE procedure) is a simplified method of performing ERCP in Roux-en-Y gastric bypass patients. The EDGE procedure involves placement of a lumen-apposing metal stent (LAMS) into the excluded stomach to serve as a conduit for passage of the duodenoscope for pancreatobiliary intervention. Originally a multistep process, urgent indications for ERCP have led to the development of single-session EDGE (SS-EDGE) with LAMS placement and ERCP performed in the same session. The goal of this study was to identify predictive factors of intraprocedural LAMS migration in SS-EDGE.
METHODS: We conducted a multicenter retrospective review that included 9 tertiary medical centers across the United States. Data were collected and analyzed from 128 SS-EDGE procedures. The primary outcome was intraprocedural LAMS migration. Secondary outcomes were other procedural adverse events such as bleeding and perforation.
RESULTS: Eleven LAMS migrations were observed in 128 procedures (8.6%). Univariate analysis of clinically relevant variables was performed, as was a binary logistic regression analysis of stent diameter and stent dilation. This revealed that use of a smaller (15 mm) diameter LAMS was an independent predictor of intraprocedural stent migration (odds ratio, 5.36; 95% confidence interval, 1.29-22.24; P = .021). Adverse events included 3 patients who required surgery and 2 who experienced intraprocedural bleeding.
CONCLUSIONS: Use of a larger-diameter LAMS is a predictive factor for a nonmigrated stent and improved procedural success in SS-EDGE. Although larger patient cohorts are needed to adequately assess these findings, performance of LAMS dilation and fixation may also decrease risk of intraprocedural LAMS migration and improve procedural success.
Volume
94
Issue
4
First Page
727
Last Page
732
ISSN
1097-6779
Published In/Presented At
Shinn, B., Boortalary, T., Raijman, I., Nieto, J., Khara, H. S., Kumar, S. V., Confer, B., Diehl, D. L., El Halabi, M., Ichkhanian, Y., Runge, T., Kumbhari, V., Khashab, M., Tyberg, A., Shahid, H., Sarkar, A., Gaidhane, M., Bareket, R., Kahaleh, M., Piraka, C., … Loren, D. (2021). Maximizing success in single-session EUS-directed transgastric ERCP: a retrospective cohort study to identify predictive factors of stent migration. Gastrointestinal endoscopy, 94(4), 727–732. https://doi.org/10.1016/j.gie.2021.04.022
Disciplines
Medicine and Health Sciences
PubMedID
33957105
Department(s)
Fellows and Residents
Document Type
Article