{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T21:27:48Z","timestamp":1789766868196,"version":"4.0.1"},"reference-count":75,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Patients with Roux-en-Y gastric bypass (RYGB) are a significant challenge for endoscopic retrograde cholangiopancreatography (ERCP) due to the altered anatomy. Endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) has emerged as a valuable alternative to standard methods like enteroscopy-assisted (EA-ERCP) and laparoscopy-assisted (LA-ERCP) ERCP. EDGE involves creating a temporary fistula between the gastric pouch and the excluded stomach under EUS guidance, typically using a lumen-apposing metal stent (LAMS). This allows a standard ERCP scope to access the second duodenum and the biliary tree with standard devices. Several studies have investigated the efficacy and safety of this approach, with variations in techniques such as suturing the LAMS to prevent migration. EDGE has demonstrated high technical success rates, and current evidence indicates that it can be performed safely, with acceptable rates of adverse events such as stent migration, bleeding, and perforation, making it the preferred option in referral centers. This comprehensive review aims to provide a concise evaluation of EDGE, its techniques, outcomes, and role in managing biliary and pancreatic disorders in RYGB patients.<\/jats:p>","DOI":"10.3390\/jcm14165675","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T11:02:09Z","timestamp":1754910129000},"page":"5675","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography (EDGE): Techniques, Outcomes and Safety Profiles"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5453-3310","authenticated-orcid":false,"given":"Filippo","family":"Antonini","sequence":"first","affiliation":[{"name":"Gastroenterology and Interventional Endoscopy Unit, Mazzoni Hospital AST Ascoli Piceno, 63100 Ascoli Piceno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9335-6740","authenticated-orcid":false,"given":"Giacomo Emanuele Maria","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, IRCCS-ISMETT, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7280-1761","authenticated-orcid":false,"given":"Giuseppe","family":"Vanella","sequence":"additional","affiliation":[{"name":"Pancreatobiliary Endoscopy and EUS Division, San Raffaele Scientific Institute IRCCS, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8618-2447","authenticated-orcid":false,"given":"Lorenzo","family":"Fuccio","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Surgery, University of Bologna, 40138 Bologna, Italy"},{"name":"Gastroenterology Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7724-7402","authenticated-orcid":false,"given":"Andrea","family":"Lisotti","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Hospital of Imola, University of Bologna, 40026 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2039-5022","authenticated-orcid":false,"given":"Michiel","family":"Bronswijk","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, Imelda Hospital, 2820 Bonheiden, Belgium"},{"name":"Gastroenterology and Hepatology, KU Leuven University Hospitals Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique","family":"P\u00e9rez-Cuadrado-Robles","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Georges-Pompidou European Hospital, 75015 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1148-9684","authenticated-orcid":false,"given":"Cecilia","family":"Binda","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Forl\u00ec-Cesena Hospitals, AUSL Romagna, 47121 Forl\u00ec-Cesena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9068-3209","authenticated-orcid":false,"given":"Stefano","family":"Mazza","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, IRCCS Foundation Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Anderloni","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, IRCCS Foundation Policlinico San Matteo, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Medical Therapeutics, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0670-9910","authenticated-orcid":false,"given":"Carlo","family":"Fabbri","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Forl\u00ec-Cesena Hospitals, AUSL Romagna, 47121 Forl\u00ec-Cesena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Tarantino","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, IRCCS-ISMETT, 90127 Palermo, 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