SINGLE-SESSION VERSUS TWO-SESSION ENDOSCOPIC ULTRASOUND-DIRECTED TRANSGASTRIC ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (EDGE): A SYSTEMATIC REVIEW AND META-ANALYSIS OF OUTCOMES IN GASTRIC BYPASS PATIENTS
DDW ePoster Library. Maipang K. 05/02/26; 4206284; Sp192
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Abstract
Discussion Forum (0)
Background:
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass (RYGB) is challenging because standard access to the duodenum is no longer feasible due to surgically altered anatomy. Endoscopic ultrasound-directed transgastric ERCP (EDGE), also known as Gastric Access Temporary for Endoscopy (GATE), enables biliary, pancreatic, and therapeutic EUS interventions by creating a temporary anastomosis using a lumen-apposing metal stent (LAMS). EDGE can be performed using either a single-session or two-session approach; however, comparative data on procedural outcomes, including LAMS migration, are not well established.
Methods:
A systematic search of EMBASE, Scopus, Web of Science, and PubMed was performed according to PRISMA and MOOSE guidelines. Eligible studies reporting outcomes of single- versus two-session GATE were included. Pooled proportions were generated for technical success, adverse events, and LAMS migration. Relative risks (RR), 95% confidence intervals (CI), and P values (<0.05 considered significant) were calculated for dichotomous outcomes.
Results:
A total of sixteen articles were screened. Four retrospective studies fulfilled the eligibility criteria and were included in the final analysis, representing 272 patients (120 single-session EDGE and 152 two-session EDGE). Technical success did not differ significantly between groups (RR 0.982; 95% CI 0.950–1.015; P=0.273; I2=0%). Adverse event rates were comparable (RR 1.686; 95% CI 0.445–6.380; P=0.442; I2=41%). Similarly, no significant difference was observed in LAMS migration (RR 1.497; 95% CI 0.860–2.606; P=0.154; I2=0%) (Figure 1). Overall, pooled analyses demonstrated no meaningful differences in efficacy or safety between single- and two-session EDGE.
Conclusion:
Single-session and two-session EDGE demonstrate comparable technical and safety outcomes, including similar rates of adverse events and LAMS migration. These findings suggest that either approach may be selected based on patient factors and local expertise rather than differences in clinical performance. However, current evidence is insufficient to assess long-term fistula outcomes, highlighting the need for prospective studies with extended follow-up.
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass (RYGB) is challenging because standard access to the duodenum is no longer feasible due to surgically altered anatomy. Endoscopic ultrasound-directed transgastric ERCP (EDGE), also known as Gastric Access Temporary for Endoscopy (GATE), enables biliary, pancreatic, and therapeutic EUS interventions by creating a temporary anastomosis using a lumen-apposing metal stent (LAMS). EDGE can be performed using either a single-session or two-session approach; however, comparative data on procedural outcomes, including LAMS migration, are not well established.
Methods:
A systematic search of EMBASE, Scopus, Web of Science, and PubMed was performed according to PRISMA and MOOSE guidelines. Eligible studies reporting outcomes of single- versus two-session GATE were included. Pooled proportions were generated for technical success, adverse events, and LAMS migration. Relative risks (RR), 95% confidence intervals (CI), and P values (<0.05 considered significant) were calculated for dichotomous outcomes.
Results:
A total of sixteen articles were screened. Four retrospective studies fulfilled the eligibility criteria and were included in the final analysis, representing 272 patients (120 single-session EDGE and 152 two-session EDGE). Technical success did not differ significantly between groups (RR 0.982; 95% CI 0.950–1.015; P=0.273; I2=0%). Adverse event rates were comparable (RR 1.686; 95% CI 0.445–6.380; P=0.442; I2=41%). Similarly, no significant difference was observed in LAMS migration (RR 1.497; 95% CI 0.860–2.606; P=0.154; I2=0%) (Figure 1). Overall, pooled analyses demonstrated no meaningful differences in efficacy or safety between single- and two-session EDGE.
Conclusion:
Single-session and two-session EDGE demonstrate comparable technical and safety outcomes, including similar rates of adverse events and LAMS migration. These findings suggest that either approach may be selected based on patient factors and local expertise rather than differences in clinical performance. However, current evidence is insufficient to assess long-term fistula outcomes, highlighting the need for prospective studies with extended follow-up.
Background:
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass (RYGB) is challenging because standard access to the duodenum is no longer feasible due to surgically altered anatomy. Endoscopic ultrasound-directed transgastric ERCP (EDGE), also known as Gastric Access Temporary for Endoscopy (GATE), enables biliary, pancreatic, and therapeutic EUS interventions by creating a temporary anastomosis using a lumen-apposing metal stent (LAMS). EDGE can be performed using either a single-session or two-session approach; however, comparative data on procedural outcomes, including LAMS migration, are not well established.
Methods:
A systematic search of EMBASE, Scopus, Web of Science, and PubMed was performed according to PRISMA and MOOSE guidelines. Eligible studies reporting outcomes of single- versus two-session GATE were included. Pooled proportions were generated for technical success, adverse events, and LAMS migration. Relative risks (RR), 95% confidence intervals (CI), and P values (<0.05 considered significant) were calculated for dichotomous outcomes.
Results:
A total of sixteen articles were screened. Four retrospective studies fulfilled the eligibility criteria and were included in the final analysis, representing 272 patients (120 single-session EDGE and 152 two-session EDGE). Technical success did not differ significantly between groups (RR 0.982; 95% CI 0.950–1.015; P=0.273; I2=0%). Adverse event rates were comparable (RR 1.686; 95% CI 0.445–6.380; P=0.442; I2=41%). Similarly, no significant difference was observed in LAMS migration (RR 1.497; 95% CI 0.860–2.606; P=0.154; I2=0%) (Figure 1). Overall, pooled analyses demonstrated no meaningful differences in efficacy or safety between single- and two-session EDGE.
Conclusion:
Single-session and two-session EDGE demonstrate comparable technical and safety outcomes, including similar rates of adverse events and LAMS migration. These findings suggest that either approach may be selected based on patient factors and local expertise rather than differences in clinical performance. However, current evidence is insufficient to assess long-term fistula outcomes, highlighting the need for prospective studies with extended follow-up.
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass (RYGB) is challenging because standard access to the duodenum is no longer feasible due to surgically altered anatomy. Endoscopic ultrasound-directed transgastric ERCP (EDGE), also known as Gastric Access Temporary for Endoscopy (GATE), enables biliary, pancreatic, and therapeutic EUS interventions by creating a temporary anastomosis using a lumen-apposing metal stent (LAMS). EDGE can be performed using either a single-session or two-session approach; however, comparative data on procedural outcomes, including LAMS migration, are not well established.
Methods:
A systematic search of EMBASE, Scopus, Web of Science, and PubMed was performed according to PRISMA and MOOSE guidelines. Eligible studies reporting outcomes of single- versus two-session GATE were included. Pooled proportions were generated for technical success, adverse events, and LAMS migration. Relative risks (RR), 95% confidence intervals (CI), and P values (<0.05 considered significant) were calculated for dichotomous outcomes.
Results:
A total of sixteen articles were screened. Four retrospective studies fulfilled the eligibility criteria and were included in the final analysis, representing 272 patients (120 single-session EDGE and 152 two-session EDGE). Technical success did not differ significantly between groups (RR 0.982; 95% CI 0.950–1.015; P=0.273; I2=0%). Adverse event rates were comparable (RR 1.686; 95% CI 0.445–6.380; P=0.442; I2=41%). Similarly, no significant difference was observed in LAMS migration (RR 1.497; 95% CI 0.860–2.606; P=0.154; I2=0%) (Figure 1). Overall, pooled analyses demonstrated no meaningful differences in efficacy or safety between single- and two-session EDGE.
Conclusion:
Single-session and two-session EDGE demonstrate comparable technical and safety outcomes, including similar rates of adverse events and LAMS migration. These findings suggest that either approach may be selected based on patient factors and local expertise rather than differences in clinical performance. However, current evidence is insufficient to assess long-term fistula outcomes, highlighting the need for prospective studies with extended follow-up.
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