Single‐session endoscopic ultrasound‐directed transgastric endoscopic retrograde cholangiopancreatography with a dedicated over‐the‐scope fixation device: Feasibility study (with video)

Abstract

ObjectivesEndoscopic ultrasound‐directed transgastric endoscopic retrograde cholangiopancreatography (ERCP; EDGE) is proposed as a less invasive alternative to laparoscopy‐assisted ERCP. However, postponing ERCP for 1–2 weeks to reduce the risk of lumen‐apposing metal stent (LAMS) migration may not be practical in urgent cases such as cholangitis, leading to increased procedural burden. This study aimed to assess the feasibility and safety of a single‐session EDGE utilizing a dedicated over‐the‐scope fixation device.MethodsA retrospective analysis of prospectively collected data from three referral centers was performed, including consecutive single‐session EDGE procedures with the Stentfix device, utilizing only 20 × 10 mm LAMS. The primary outcome was LAMS migration, and key secondary outcomes included adverse events and technical success.ResultsTwenty patients (mean age 59 [standard deviation (SD) ± 11.3] years, 65.0% female) with a predominantly classic Roux‐en‐Y gastric bypass history (90.0%, mini‐bypass 10.0%) underwent ERCP for indications such as common bile duct stones (60.0%), cholangitis (25.0%), or biliary pancreatitis (15.0%). No LAMS migration occurred, and technical success was achieved in 95.0%. Over a median follow‐up of 102 days (interquartile range [IQR] 24.8–182), two adverse events were reported (10.0%), comprising postprocedural pain (grade I) and post‐ERCP pancreatitis (grade II).ConclusionWhile acknowledging potential contributions from LAMS orientation and stent caliber, our data suggest that utilizing a dedicated over‐the‐scope stent fixation device may effectively prevent LAMS migration during single‐session EDGE without the need for endoscopic suturing.