EUS-Directed Transgastric ERCP (EDGE) Versus Laparoscopy-Assisted ERCP (LA-ERCP) For Roux-En-Y Gastric Bypass (RYGB) Anatomy: Systemic Review and Metanalysis

Objective: Laparoscopic-assisted endoscopic retrograde cholangiopancreatography (LA-ERCP) has gained popularity and was considered the preferred therapeutic option across multiple institutions in managing choledocholithiasis after bariatric surgery. As of recent, a novel procedure, endoscopic ultrasound directed transgastric ERCP (EDGE), has gained popularity across the USA and Europe. We sought to assess and compare the safety and technical success of both procedures. Methods: We conducted a systematic review following the PRISMA guidelines. A total of 925 articles were screened and assessed for inclusions. Two authors independently screend abstracts and titles followed up full-text screening. Articles comparing outcomes between both surgical techniques were included in this study. A meta-analysis was conducted to compare peri-operative outcomes between both procedures. Results: A total of four articles met the inclusion criteria. All four articles were retrospective reviews. The mean age was 52 and the majority were females. When comparing outcomes between both procedures, no difference in adverse events, technical success rates and pancreatitis was detected. Compared to the LA-ERCP cohort, the EDGE cohort had a shorter hospital Length of Stay (LOS) and operative time. Using the Ottawa scale, a moderate risk of bias was assessed across all four articles. Conclusion: Based on the results of this meta-analysis, EDGE was associated with a shorter LOS and operative time with no increased risk of adverse events. Additionally, based procedures had a high technical success rate.