Endoscopic ultrasound–directed transgastric ERCP (EDGE) has emerged as a transformative technique for managing biliary and pancreatic diseases in patients with Roux-en-Y gastric bypass (RYGB) anatomy. Traditional ERCP is technically challenging in RYGB due to altered anatomy, often requiring enteroscopy-assisted ERCP or laparoscopic-assisted ERCP—both limited by lower success rates or higher invasiveness.
Endoscopic ultrasound–directed transgastric ERCP (EDGE) has emerged as a transformative technique for managing biliary and pancreatic diseases in patients with Roux-en-Y gastric bypass (RYGB) anatomy. Traditional ERCP is technically challenging in RYGB due to altered anatomy, often requiring enteroscopy-assisted ERCP or laparoscopic-assisted ERCP—both limited by lower success rates or higher invasiveness.
EDGE overcomes these barriers by creating a temporary gastrogastric or jejunogastric fistula using a lumen-apposing metal stent under EUS guidance, enabling access to the excluded stomach and standard duodenoscope-assisted ERCP. Reported technical and clinical success rates exceed 90%, with shorter procedure times and high therapeutic efficacy.
Adverse events include stent migration, bleeding, and persistent fistula, though most are manageable. Compared to surgical or enteroscopy-based approaches, EDGE offers a minimally invasive, highly effective alternative and is increasingly considered first-line in expert centres for RYGB patients requiring ERCP.
Introduction: Endoscopic metabolic therapies have emerged as less invasive alternatives to bariatric surgery for patients with obesity and poorly controlled type 2 diabetes mellitus (T2DM). The EndoBarrier duodenal-jejunal bypass liner (DJBL) is an endoscopically placed...
Introduction: Endoscopic ultrasound (EUS)-guided transmural drainage is the standard minimally invasive treatment for symptomatic necrotizing pancreatitis. However, the optimal timing of direct endoscopic necrosectomy (DEN) following drainage remains uncertain. While the conventional step-up approach reserves...
Introduction: Bevacizumab is widely used in metastatic colorectal cancer (mCRC) because of its survival benefits but is associated with impaired wound healing, gastrointestinal perforation, and bleeding. These concerns often lead clinicians to delay endoscopic procedures...
Introduction: Endoscopic submucosal dissection (ESD) enables en bloc resection of large colorectal neoplasms with excellent oncological outcomes. However, concerns about perforation have limited its widespread adoption. This large prospective multicenter study evaluated the incidence, risk...
Introduction: Obesity has become one of the greatest global health challenges. New incretin-based therapies—including semaglutide, tirzepatide, resmetirom, and SGLT2 inhibitors such as empagliflozin—have transformed the treatment of obesity, diabetes, and MASLD. However, many patients discontinue...
Introduction: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is the standard technique for diagnosing solid pancreatic lesions. Traditionally, biopsy specimens are processed for cytology, often requiring on-site cytopathology support. This multicenter prospective study evaluated whether directly placing...
We are pioneers in clinical intelligence, dedicated to helping gastroenterologists harness the power of artificial intelligence to drive precision, efficiency, and patient growth.