Maximizing success in single-session EUS-directed transgastric ERCP: a retrospective cohort study to identify predictive factors of stent migration

Brianna Shinn, Tina Boortalary, Isaac Raijman, Jose Nieto, Harshit S. Khara, S. Vikas Kumar, Bradley Confer, David L. Diehl, Maan El Halabi, Yervant Ichkhanian, Thomas Runge, Vivek Kumbhari, Mouen Khashab, Amy Tyberg, Haroon Shahid, Avik Sarkar, Monica Gaidhane, Romy Bareket, Michel Kahaleh, Cyrus PirakaTobias Zuchelli, Ryan Law, Arjun Sondhi, Prashant Kedia, Justin Robbins, Cristina Calogero, Mena Bakhit, Austin Chiang, Alexander Schlachterman, Thomas Kowalski, David Loren

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.

Original languageEnglish (US)
Pages (from-to)727-732
Number of pages6
JournalGastrointestinal endoscopy
Volume94
Issue number4
DOIs
StatePublished - Oct 2021

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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