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Honda H, Mosko JD, Kobayashi R, Fecso A, Kim BS, Scott S, May GR. Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography for patients with Roux-en-Y gastric bypass anatomy: technical overview. Clin Endosc 2022; 55:736-741. [PMID: 36464820 PMCID: PMC9726442 DOI: 10.5946/ce.2022.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/06/2022] [Indexed: 11/30/2022] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass anatomy is a well-documented challenge. Traditionally, this problem has been overcome with adjunctive techniques, such as device-assisted ERCP, including double-balloon or single-balloon enteroscopy and laparoscopy-assisted transgastric ERCP. Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a novel technique that enables access to the ampulla using a duodenoscope without surgical intervention and has shown high clinical and technical success rates in recent studies. However, this approach is technically demanding, necessitating a thorough understanding of the gastrointestinal anatomy as well as high operator experience. In this review, we provide a technical overview of EDGE in parallel with our personal experience at our center and propose a simple algorithm to select patients for its appropriate application. In conjunction, the outcomes of EDGE compared with those of device-assisted and laparoscopy-assisted transgastric ERCP will be discussed.
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Affiliation(s)
- Hirokazu Honda
- The Centre for Therapeutic Endoscopy and Endoscopic Oncology and Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Jeffrey D. Mosko
- The Centre for Therapeutic Endoscopy and Endoscopic Oncology and Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Ryosuke Kobayashi
- The Centre for Therapeutic Endoscopy and Endoscopic Oncology and Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Andras Fecso
- The Centre for Therapeutic Endoscopy and Endoscopic Oncology and Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Bong Sik Kim
- The Centre for Therapeutic Endoscopy and Endoscopic Oncology and Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Schoeman Scott
- The Centre for Therapeutic Endoscopy and Endoscopic Oncology and Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Gary R. May
- The Centre for Therapeutic Endoscopy and Endoscopic Oncology and Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada,Correspondence: Gary R. May The Centre for Therapeutic Endoscopy and Endoscopic Oncology and Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada E-mail:
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McCarty TR, Thompson CC. Lumen Apposition: A Changing Landscape in Therapeutic Endoscopy. Dig Dis Sci 2022; 67:1660-1673. [PMID: 35430698 DOI: 10.1007/s10620-022-07426-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 12/09/2022]
Abstract
The concept of endoscopic lumen apposition has seen a dramatic shift in the last several decades. Early natural orifice trans-luminal endoscopic surgery (NOTES) concepts have transformed into specialized lumen-apposing metal stents (LAMSs) and delivery devices, which provide endoscopists a minimally invasive alternative to surgical intervention. These LAMSs have become the bedrock of therapeutic endoscopy and provide treatment for a wide spectrum of gastrointestinal disorders. In this review, we summarize the changing landscape of therapeutic endoscopy by highlighting the use of LAMS and future directions as well as alternative devices to achieve lumen apposition.
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Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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Abstract
The concept of endoscopic lumen apposition has seen a dramatic shift in the last several decades. Early natural orifice trans-luminal endoscopic surgery (NOTES) concepts have transformed into specialized lumen-apposing metal stents (LAMSs) and delivery devices, which provide endoscopists a minimally invasive alternative to surgical intervention. These LAMSs have become the bedrock of therapeutic endoscopy and provide treatment for a wide spectrum of gastrointestinal disorders. In this review, we summarize the changing landscape of therapeutic endoscopy by highlighting the use of LAMS and future directions as well as alternative devices to achieve lumen apposition.
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Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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