Interventional Endoscopic Ultrasound (EUS) | October 2026-EDGE Case Demo and Troubleshooting

Video Transcription

Video Summary

Dr. Darius Jahan presented practical troubleshooting strategies for EDGE (EUS-directed transgastric ERCP) in patients with Roux-en-Y gastric bypass. He emphasized choosing a high, proximal remnant-stomach site for LAMS placement to provide a favorable angle for duodenoscope passage; the best site for injecting and distending the remnant may differ from the best stent location. Fluoroscopy, careful contrast injection, patient positioning, glucagon, and taking time to confirm correct placement can reduce risk.<br /><br />For difficult scope passage, the panel discussed dilating the LAMS and pylorus, using back traction with a balloon catheter, considering a slimmer or disposable duodenoscope, and adding fixation when early passage may place tension on the tract. Migration can sometimes be managed by rewiring and placing a bridging covered stent; if access is lost, close the pouch defect and create a new tract later if needed.<br /><br />The speakers generally favored staged EDGE when clinically feasible, particularly with 15-mm stents, reserving single-session EDGE for urgent indications and securing the LAMS first. They also discussed persistent fistula and weight regain, recommending LAMS removal, tract closure, and follow-up imaging.

Asset Subtitle

Darius Jahann, MD

Meta Tag

Concept Endoscopic Ultrasound-Directed Transgastric ERCP

Concept Puncture Site

Concept Stent Deployment Site

Concept Access Tract

Concept Lumen-Apposing Metal Stent

Keywords

EDGE

Roux-en-Y gastric bypass

LAMS placement

duodenoscope passage

fluoroscopy

stent migration

persistent fistula

Endoscopic Ultrasound-Directed Transgastric ERCP

Puncture Site

Stent Deployment Site

Access Tract

Lumen-Apposing Metal Stent