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Background <p>Endoscopic ultrasound-directed transgastric ERCP (EDGE) is increasingly used for pancreaticobiliary access in patients with Roux-en-Y gastric bypass (RYGB). However, concerns persist regarding long-term fistula persistence and weight regain after lumen-apposing metal stent (LAMS) removal. Long-term outcome data remain limited.</p> Methods <p>We performed a retrospective study of a prospectively maintained database at a tertiary academic center including RYGB patients who underwent EDGE between June 2018 and November 2024. Outcomes included fistula persistence or recurrence after LAMS removal, weight change during LAMS indwell and long-term follow-up, technical success, and adverse events. Fistula status was assessed by imaging and/or endoscopy when available. Adverse events were graded using the AGREE classification, a validated adverse events grading system.</p> Results <p>Seventy-three patients underwent EDGE. ERCP technical success was achieved in 93%. Median LAMS indwell duration was 65&#xa0;days. Objective fistula reassessment was performed in 92% of patients. Persistent or recurrent fistula was identified in 3 patients (4%), all initially treated with 20&#xa0;mm LAMS and endoscopic closure, with successful repeat endoscopic therapy when pursued. Five adverse events occurred (6.8%), including four requiring surgery. During LAMS indwell, median weight change was − 1.5&#xa0;kg (IQR − 4.0 to + 1.0). At median follow-up of 4.9&#xa0;years after LAMS removal, median weight change was + 3.1&#xa0;kg (IQR 2.4–3.3), with no statistically significant difference by fistula closure strategy or access route.</p> Conclusions <p>EDGE provides effective pancreaticobiliary access in RYGB patients with low rates of long-term fistula persistence and modest weight change consistent with expected post-bariatric trajectories. These findings support the long-term safety and durability of EDGE with selective fistula closure strategies.</p>

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Weight matters: long-term evaluation of weight regain and fistula recurrence post endoscopic ultrasound-directed transgastric ERCP (EDGE)

  • 期刊论文

  • 发表日期：

    2026年7月7日

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  • Yervant Ichkhanian,
  • Adel Hajj Ali,
  • Jeffrey J. Easler,
  • Ite Obaitan,
  • James L. Watkins,
  • Evan L. Fogel,
  • Nasir Saleem,
  • John DeWitt,
  • Mohammad Al-Haddad,
  • Mark A. Gromski,
  • Sujani Yadlapati

摘要

Background

Endoscopic ultrasound-directed transgastric ERCP (EDGE) is increasingly used for pancreaticobiliary access in patients with Roux-en-Y gastric bypass (RYGB). However, concerns persist regarding long-term fistula persistence and weight regain after lumen-apposing metal stent (LAMS) removal. Long-term outcome data remain limited.

Methods

We performed a retrospective study of a prospectively maintained database at a tertiary academic center including RYGB patients who underwent EDGE between June 2018 and November 2024. Outcomes included fistula persistence or recurrence after LAMS removal, weight change during LAMS indwell and long-term follow-up, technical success, and adverse events. Fistula status was assessed by imaging and/or endoscopy when available. Adverse events were graded using the AGREE classification, a validated adverse events grading system.

Results

Seventy-three patients underwent EDGE. ERCP technical success was achieved in 93%. Median LAMS indwell duration was 65 days. Objective fistula reassessment was performed in 92% of patients. Persistent or recurrent fistula was identified in 3 patients (4%), all initially treated with 20 mm LAMS and endoscopic closure, with successful repeat endoscopic therapy when pursued. Five adverse events occurred (6.8%), including four requiring surgery. During LAMS indwell, median weight change was − 1.5 kg (IQR − 4.0 to + 1.0). At median follow-up of 4.9 years after LAMS removal, median weight change was + 3.1 kg (IQR 2.4–3.3), with no statistically significant difference by fistula closure strategy or access route.

Conclusions

EDGE provides effective pancreaticobiliary access in RYGB patients with low rates of long-term fistula persistence and modest weight change consistent with expected post-bariatric trajectories. These findings support the long-term safety and durability of EDGE with selective fistula closure strategies.