{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:03:43Z","timestamp":1791979423851,"version":"4.4.0"},"reference-count":23,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,4,23]],"date-time":"2023-04-23T00:00:00Z","timestamp":1682208000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Little is known about how to perform the endoscopic ultrasound (EUS)\u2010directed transgastric endoscopic retrograde cholangiopancreatography (ERCP; EDGE) in patients with gastric bypass using lumen\u2010apposing metal stents (LAMS). The aim was to assess the risk factors of anastomosis\u2010related difficult ERCP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Observational single\u2010center study. All patients who underwent an EDGE procedure in 2020\u20132022 following a standardized protocol were included. Risk factors for difficult ERCP, defined as the need of &gt;5\u2009min LAMS dilation or failure to pass a duodenoscope in the second duodenum, were assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010five ERCPs were performed in 31 patients (57.4\u00a0\u00b1\u20098.2\u2009years old, 38.7% male). The EUS procedure was done using a wire\u2010guided technique (<jats:italic>n<\/jats:italic>\u00a0=\u200928, 90.3%) for biliary stones (<jats:italic>n<\/jats:italic>\u00a0=\u200922, 71%) in most cases. The location of the anastomosis was gastro\u2010gastric (<jats:italic>n<\/jats:italic>\u00a0=\u200924, 77.4%) and mainly in the middle\u2010excluded stomach (<jats:italic>n<\/jats:italic>\u00a0=\u200921, 67.7%) with an oblique axis (<jats:italic>n<\/jats:italic>\u00a0=\u200922, 71%). The ERCP technical success was 96.8%. There were 10 difficult ERCPs (32.3%) due to timing (<jats:italic>n<\/jats:italic>\u00a0=\u20098), anastomotic dilation (<jats:italic>n<\/jats:italic>\u00a0=\u20098), or failure to pass (<jats:italic>n<\/jats:italic>\u00a0=\u20093). By multivariable analysis adjusted by two\u2010stage procedures, the risk factors for a difficult ERCP were the jejuno\u2010gastric route (85.7% vs. 16.7%; odds ratio [OR<jats:sub>a<\/jats:sub>] 31.875; 95% confidence interval [CI] 1.649\u2013616.155; <jats:italic>P<\/jats:italic>\u00a0=\u20090.022), and the anastomosis to the proximal\/distal excluded stomach (70% vs. 14.3%; OR<jats:sub>a<\/jats:sub> 22.667; 95% CI 1.676\u2013306.570; <jats:italic>P<\/jats:italic>\u00a0=\u20090.019). There was only one complication (3.2%) and one persistent gastro\u2010gastric fistula (3.2%) in a median follow\u2010up of 4\u2009months (2\u201318 months), with no weight regain (<jats:italic>P<\/jats:italic>\u00a0=\u20090.465).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The jejunogastric route and the anastomosis with the proximal\/distal excluded stomach during the EDGE procedure increase the difficulty of ERCP.<\/jats:p><\/jats:sec>","DOI":"10.1111\/den.14544","type":"journal-article","created":{"date-parts":[[2023,3,6]],"date-time":"2023-03-06T04:21:02Z","timestamp":1678076462000},"page":"909-917","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Risk factors of anastomosis\u2010related difficult endoscopic retrograde cholangiopancreatography following endoscopic ultrasound\u2010guided gastro\u2010gastrostomy using a\u00a0standardized protocol (with video)"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8254-7453","authenticated-orcid":false,"given":"Enrique","family":"P\u00e9rez\u2010Cuadrado\u2010Robles","sequence":"first","affiliation":[{"name":"&gt;Department of Gastroenterology Georges\u2010Pompidou European Hospital, Assistance Publique\u2010H\u00f4pitaux de Paris  Paris France"},{"name":"Paris Cit\u00e9 University  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadrien","family":"Alric","sequence":"additional","affiliation":[{"name":"&gt;Department of Gastroenterology Georges\u2010Pompidou European Hospital, Assistance Publique\u2010H\u00f4pitaux de Paris  Paris France"},{"name":"Paris Cit\u00e9 University  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5443-2579","authenticated-orcid":false,"given":"Lucille","family":"Qu\u00e9n\u00e9herv\u00e9","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology University Hospital of Brest  Brest France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7922-0396","authenticated-orcid":false,"given":"Laurent","family":"Monino","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Universit\u00e9 catholique de Louvain, Cliniques universitaires Saint\u2010Luc  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tigran","family":"Poghosyan","sequence":"additional","affiliation":[{"name":"Paris Cit\u00e9 University  Paris France"},{"name":"Department of Surgery Bichat Hospital, Assistance Publique\u2010H\u00f4pitaux de Paris  Paris 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