Gastric access temporary for endoscopy (GATE): a proposed algorithm for EUS-directed transgastric ERCP in gastric bypass patients.

Surgical Endoscopy
Thomas J WangMarvin Ryou

Abstract

Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass (RYGB) anatomy is technically challenging. Device-assisted enteroscopy and laparoscopic-assisted methods suffer from high failure rates and/or post-procedural complications. A novel endoscopic technique termed EUS-Directed Transgastric ERCP (EDGE) or Gastric Access Temporary for Endoscopy (GATE) has recently emerged, demonstrating excellent technical and therapeutic success. The technique involves endoscopic ultrasound-guided deployment of a lumen-apposing metal stent (LAMS) to gain access into the remnant stomach to facilitate standard ERCP. In this case series, we describe our center's experience and unique approach with the GATE procedure and discuss several key strategies and differences. Patients underwent the GATE procedure via a novel algorithmic approach. Key information on procedural details, technical and clinical success, follow-up, and adverse events was prospectively collected and retrospectively reviewed. 10 patients underwent the GATE procedure from May 2017 to March 2018. Technical and clinical success were both 100%. Gastric and jejunal access points for LAMS deployment were 30% and 70%, respectively. Tota...Continue Reading

References

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Citations

Nov 13, 2019·The American Journal of Gastroenterology·Erin Forster, B Joseph Elmunzer
Jun 20, 2020·World Journal of Gastroenterology : WJG·Prabin SharmaChristopher C Thompson
Jan 5, 2021·Annals of Surgery Open : Perspectives of Surgical History, Education, and Clinical Approaches·Mariano GiménezJacques Marescaux
Apr 23, 2021·VideoGIE : an Official Video Journal of the American Society for Gastrointestinal Endoscopy·Jessica JouTobias Zuchelli
Jun 19, 2021·VideoGIE : an Official Video Journal of the American Society for Gastrointestinal Endoscopy·Hirokazu HondaGary R May
Aug 6, 2021·Endoscopy·Prashant Kedia

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