Layth Alzubaidy, MD1, Sufiyan Kamal, MD2, Muhammad Baig, MD2 1UT Health Science Center-Tyler, Tyler, TX; 2UT Health Tyler, Tyler, TX Introduction: Endoscopic ultrasound-directed transgastric ERCP (EDGE) is becoming a widely used technique for accessing the pancreatico-biliary system in patients with Roux-en-Y gastric bypass (RYGB) anatomy. Although typically performed at tertiary care centers by seasoned advanced endoscopists, there is limited evidence on its utilization by early-career advanced gastroenterologists. This study assesses the safety and effectiveness of EDGE when performed by gastroenterologists within two years of completing their advanced endoscopy training. Methods: A retrospective review was performed at a single center, involving 12 consecutive patients who underwent EDGE procedures carried out by early-career advanced gastroenterologists. The primary outcomes assessed were technical and clinical success. Technical success was defined as the successful creation of a gastro-gastric fistula with access to the excluded stomach and ampulla. Clinical success referred to the resolution of the underlying condition, such as cholangitis or biliary obstruction. Secondary outcomes included procedure-related adverse events. Results: All patients in the study were female, with an average age of 61.5 years and a mean BMI of 28.8 ± 8.9 kg/m². The cohort consisted of 75% White and 25% African American individuals. Common comorbid conditions included hypertension (67%), chronic obstructive pulmonary disease (COPD) (25%), and diabetes mellitus (25%).
Both technical and clinical success rates were 100% (12 out of 12). No immediate mortality was observed. One patient (8%) with advanced malignancy and limited baseline survival passed away during follow-up; this was deemed unrelated to the procedure. There was a single instance (8%) of stent migration during a single-session EDGE procedure, which was successfully managed with endoscopic repositioning and resulted in no complications. No cases of perforation, bleeding, or infection were reported. Discussion: This study highlights that EDGE can be performed safely and effectively by early-career advanced gastroenterologists. The procedure was associated with high technical and clinical success rates and a low incidence of complications. These results support the potential for broader adoption of EDGE beyond high-volume tertiary centers, provided that it is performed by adequately trained clinicians. Further large-scale, prospective studies are needed to validate these findings.
Figure: Table 1: Primary Outcomes
Figure: Table 2: Secondary Outcomes
Disclosures: Layth Alzubaidy indicated no relevant financial relationships. Sufiyan Kamal indicated no relevant financial relationships. Muhammad Baig indicated no relevant financial relationships.
Layth Alzubaidy, MD1, Sufiyan Kamal, MD2, Muhammad Baig, MD2. P3505 - Efficacy and Safety of Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE) Among Early Career Advanced Gastroenterologists, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
