Background : Roux-en-Y gastric bypass (RYGB) surgery is the second most common weight loss surgery, known for its success in treating obesity. However, this surgery can make endoscopic retrograde cholangiopancreatography (ERCP) technically challenging due to altered anatomy. To overcome this challenge, Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE) has been developed as a minimally invasive endoscopic procedure. In this study, we evaluated EDGE in RYGB patients.

Methods : In this study, we evaluated the clinical and technical success of the studies reported performing EDGE in RYGB patients in a systematic review study. Indications and complications were analyzed as the secondary objective.

Results : From the 76 studies on ERCP in RYGB patients, 27 study reported performing EDGE entered our first evaluation. After removing the case reports and the papers not reporting the technical and clinical success rates, 11 study were selected for the final analysis. Technical success was reported between 81.25-100% and clinical success was reported as 62.5-100%. Total of the analyzed patients were 303 patients, 293 were technically successful (96.6%) and 279 (92%) were clinically successful. Choledocholithiasis was the most prevalent indication (45.8%). 36% of all the patients developed complications. Stent migration and displacement were among the most prevalent incidences in the surgery (4.9%).

Conclusions : Technical and clinical success rate of the EDGE in RYGB patients justify this procedure. However, high complication rate of this procedure should be considered in critically ill patients.