ASGE Therapeutic EUS for Advanced Endosonographers (On-Demand) | September 2022-9_Storm Gastro

9_Storm Gastro_Gastric Fistula for EDGE

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In this document, Dr. Andy Storm discusses the technique of EDGE (Endoscopic Gastrojejunal Bypass Anastomotic Revision) for performing endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Roux-en-Y gastric bypass (RYGB) surgery. He explores different options for performing ERCP in this patient population, including enteroscopy assisted native papilla ERCP, laparoscopically assisted ERCP, percutaneous rendezvous, and EDGE. <br />Dr. Storm highlights that while EDGE can be effective in certain cases, there are important considerations to keep in mind. He notes specific scenarios when EDGE should be avoided, such as in patients with bleeding risk, ascites, unfavorable anatomy, or those who prefer to avoid weight regain. He also mentions contraindications for EDGE, such as the presence of a gastrogastric fistula or an undivided staple line. <br />The document provides a list of supplies needed for performing EDGE, including needles, contrast agents, guidewires, and stenting devices. <br />Adjacent procedures to consider, such as EUS-directed trans-enteric ERCP (EDEE) and non-ERCP remnant or small bowel access procedures, are also discussed. <br />Dr. Storm mentions some outstanding controversies surrounding EDGE, including the choice of puncture site, the safety of same-day ERCP and the need for closure of the fistula. He shares his opinion on these topics, suggesting that the decision should be patient-specific and that precautions, such as suturing and over-dilating the stent, should be taken to minimize risks. <br />In the summary, Dr. Storm emphasizes the importance of considering patient factors, having protocols and equipment prepared, and exploring the use of EDGE for other procedures in surgically altered anatomy. The document ends with a quote from MLK Jr., encouraging the building of bridges instead of walls.

Keywords

EDGE

ERCP

Roux-en-Y gastric bypass

contraindications

supplies

EUS-directed trans-enteric ERCP

controversies

puncture site

suturing

surgically altered anatomy