ASGE Therapeutic EUS for Advanced Endosonographers (Live and Virtual) | September 2022-9_Storm Gastro

9_Storm Gastro_Gastric Fistula for EDGE

Pdf Summary

This document discusses the use of EDGE (Endoscopy-directed ERCP-Entered) for the treatment of biliary diseases in patients who have undergone Roux-en-Y gastric bypass (RYGB) surgery. It highlights the challenges and limitations of other techniques such as enteroscopy-assisted ERCP and laparoscopically assisted ERCP. <br /><br />EDGE is a technique that allows for multiple ERCPs in patients with indeterminate strictures, malignancy, and challenging choledocholithiasis. It has a high success rate but can also have severe adverse events. The document mentions relative contraindications for EDGE, such as bleeding risk, ascites, unfavorable anatomy, and patient preferences. <br /><br />The document also discusses the necessary supplies for EDGE procedures, including needles, contrast agents, guidewires, and stents. It mentions adjacent procedures like EDEE (EUS-directed trans-enteric ERCP) and non-ERCP remnant or small bowel access procedures.<br /><br />There are controversies surrounding EDGE, including the best puncture site, the use of same-day ERCP, and the need for closure of the fistula. The author provides their opinions on these issues. <br /><br />In summary, the document emphasizes the importance of considering patient factors and discussing the risks and benefits of EDGE with patients. It suggests having a protocol and all necessary equipment prepared for EDGE procedures. It also suggests considering EDGE techniques for non-ERCP and adjacent procedures in surgically altered anatomy. Finally, the document concludes with a quote from MLK Jr., encouraging the building of bridges instead of walls.

Keywords

EDGE

endoscopy-directed ERCP-Entered

biliary diseases

Roux-en-Y gastric bypass

enteroscopy-assisted ERCP

laparoscopically assisted ERCP

indeterminate strictures

choledocholithiasis

relative contraindications

bleeding risk