EUS-Directed Transgastric ERCP (EDGE) in RYGB: GIE, Feb.26

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.