Background and Aims

ERCP is challenging in patients with Roux-en-Y gastric bypass (RYGB) anatomy. EUS-guided gastrogastrostomy (GG) creation is a promising novel technique to access the excluded stomach to facilitate conventional ERCP. We aimed to compare procedural outcomes and adverse events (AEs) between EUS-guided GG-assisted ERCP (EUS-GG-ERCP) and enteroscopy-assisted ERCP (e-ERCP) in patients with RYGB.

Methods

Patients with RYGB anatomy who underwent EUS-GG-ERCP or e-ERCP between 2014 and 2016 at 5 tertiary centers were included. The primary outcome was technical success of ERCP, defined as successful cannulation of the selected duct with successful intervention as intended. Secondary outcomes included total procedural time (in the EUS-GG group, total procedural time included EUS-GG creation plus ERCP procedure time), length of hospital stay, and rate/severity of AEs graded according to the American Society for Gastrointestinal Endoscopy lexicon.

Results

A total of 60 patients (mean age, 57.2 ± 13.2; 75% women) were included, of whom 30 (50%) underwent EUS-GG-ERCP and 30 (50%) underwent e-ERCP (double-balloon enteroscope ERCP, 19; single-balloon enteroscope ERCP, 11). The technical success rate was significantly higher in the EUS-GG-ERCP versus the e-ERCP group (100% vs 60.0%, P < .001). Total procedure time was significantly shorter in patients who underwent EUS-GG-ERCP (49.8 minutes vs 90.7 minutes, P < .001). Postprocedure median length of hospitalization was shorter in the EUS-GG group (1 vs 10.5 days, P = .02). Rate of AEs was similar in both groups (10% vs 6.7%, P = 1).

Conclusions

EUS-GG-ERCP may be superior to e-ERCP in patients with RYGB anatomy in terms of a higher technical success and shorter procedural times and offers a similar safety profile.

中文翻译：

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EUS指导的胃胃造口术辅助ERCP与肠镜辅助ERCP在Roux-en-Y胃旁路手术患者中的国际，多中心比较试验

背景和目标

ERCP对Roux-en-Y胃旁路（RYGB）解剖结构的患者具有挑战性。EUS引导的胃胃造口术（GG）是一种有前途的新颖技术，可进入排除的胃部以促进常规ERCP。我们旨在比较RYGB患者在EUS指导的GG辅助ERCP（EUS-GG-ERCP）和肠镜辅助的ERCP（e-ERCP）之间的手术结果和不良事件（AE）。

方法

纳入2014年至2016年在5个三级中心接受EUS-GG-ERCP或e-ERCP手术的RYGB解剖患者。主要结果是ERCP的技术成功，其定义为对选定导管的成功插管，并按预期进行了成功的干预。次要结果包括总手术时间（在EUS-GG组中，总手术时间包括EUS-GG创建加上ERCP手术时间），住院时间长短和根据美国胃肠内镜协会词汇分级的AE发生率/严重程度。

结果

包括60例患者（平均年龄57.2±13.2； 75％为女性），其中30例（50％）接受了EUS-GG-ERCP手术，30例（50％）进行了e-ERCP（双气囊肠镜ERCP）， 19；单气囊小肠镜ERCP，11）。与e-ERCP组相比，EUS-GG-ERCP的技术成功率显着更高（100％比60.0％，P  <.001）。接受EUS-GG-ERCP的患者的总手术时间明显缩短（49.8分钟vs 90.7分钟，P  <.001）。EUS-GG组的术后中位住院时间较短（1 vs 10.5天，P  = .02）。两组的不良事件发生率相似（10％比6.7％，P  = 1）。

结论

对于具有RYGB解剖结构的患者，EUS-GG-ERCP可能会在技术成功率更高，手术时间更短以及安全性相似方面优于e-ERCP。