Interventional Endoscopic Ultrasound (EUS) | October 2026-Jahann_Therapeutic EUS course

Jahann_Therapeutic EUS course - EDGE

Pdf Summary

Endoscopic ultrasound-directed transgastric ERCP (EDGE) provides access to the native papilla in patients with Roux-en-Y gastric bypass (RYGB) anatomy. The procedure creates an EUS-guided connection—typically between the gastric pouch and remnant stomach—using a lumen-apposing metal stent (LAMS), allowing a duodenoscope to reach the papilla. Related EUS-directed transgastric interventions may also enable other procedures, while transenteric access is another option.<br /><br />Patient selection should include clinical stability, a well-documented need for ERCP, review of cross-sectional imaging such as MRCP, consideration of repeat pancreatobiliary access, and assessment of local expertise and rescue resources. Multidisciplinary planning is important, including consideration of whether cholecystectomy is imminent.<br /><br />EDGE may be faster and less costly than laparoscopic-assisted ERCP (LA-ERCP), while balloon-enteroscopy-assisted ERCP can be limited by available devices. EDGE can be performed in one session, with fistula creation and ERCP together, or in two sessions, allowing time for the fistula to mature before ERCP.<br /><br />Key procedural steps include evaluating the gastroesophageal junction, pouch size, anastomosis, and anatomy; planning the fistula location; placing and securing the LAMS; dilating it to the stent diameter; passing the duodenoscope to perform ERCP; and withdrawing it slowly while maintaining wire access. Fistula closure is addressed after the intervention.<br /><br />Potential adverse events include stent maldeployment or migration, bleeding, peritonitis, and persistent fistula, including gastrogastric or jejunogastric fistulas. The presentation concludes that EDGE is increasingly favored, but success depends on preparation, an experienced team, and careful selection of the access location.

Keywords

Endoscopic ultrasound-directed transgastric ERCP

EDGE

Roux-en-Y gastric bypass

lumen-apposing metal stent

native papilla

EUS-guided access

duodenoscope

biliary access

fistula closure

laparoscopic-assisted ERCP