Colangiopancreatografía retrógrada endoscópica transgástrica guiada por ultrasonografía endoscópica en un mismo tiempo endoscópico: primer caso en la región caribe colombiana

Dagoberto Rafael Duarte Misol; Marco Antonio Medina Ortega; Fernando Luis García del Risco; Jesús Maria Pérez Orozco

doi:10.47892/rgp.2026.462.2187

Authors

Dagoberto Rafael Duarte Misol Endomedical IPS, Barranquilla, Colombia; Departamento de Gastroenterología, Universidad de Cartagena, Cartagena, Colombia. https://orcid.org/0000-0003-1206-6018
Marco Antonio Medina Ortega Endomedical IPS, Barranquilla, Colombia; Departamento de Gastroenterología, Universidad de Cartagena, Cartagena, Colombia. https://orcid.org/0000-0002-5047-5229
Fernando Luis García del Risco Endomedical IPS, Barranquilla, Colombia; Departamento de Gastroenterología, Universidad de Cartagena, Cartagena, Colombia. https://orcid.org/0000-0001-6013-7162
Jesús Maria Pérez Orozco Endomedical IPS, Barranquilla, Colombia; Departamento de Gastroenterología, Universidad de Cartagena, Cartagena, Colombia. https://orcid.org/0009-0002-3220-9610

DOI:

https://doi.org/10.47892/rgp.2026.462.2187

Keywords:

Cholangiopancreatography, Endoscopic Retrograde, Endosonography, Choledocholithiasis

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is the standard treatment for biliary tract diseases; however, in patients with Roux-en-Y gastric bypass, it is technically challenging due to altered anatomy. We report the case of a 43 year old woman with a history of gastric bypass who presented with abdominal pain, fever, and jaundice, and was diagnosed with choledocholithiasis complicated by cholangitis. After multidisciplinary evaluation, a single-session endoscopic ultrasound-guided transgastric ERCP (EDGE) was performed. A gastrogastric fistula was created using a Hot Axios lumen-apposing metal stent, which was subsequently dilated and secured to allow safe passage of the duodenoscope. During ERCP, type IV Mirizzi syndrome with an impacted stone was identified; therefore, a biliary stent was placed for drainage and infection control, with planned subsequent lithotripsy. This case highlights that the EDGE technique is an effective and minimally invasive alternative for biliary access in patients with surgically altered anatomy, demonstrating high technical success and an acceptable safety profile, and enabling treatment in a single endoscopic session.

Downloads

Download data is not yet available.

References

Costa-Barney VA, Cáceres D, Kerguelen A, Rodríguez J, Rodríguez A, Galvao M, et al. Obesity: The Role of the Gastroenterologist. Rev Colomb Gastroenterol. 2024;39(3):287- 95. doi: 10.22516/25007440.1192.

Medina GA, Rubiano AM, Roldan MV, Arango FS, Restrepo JD, Larrota LCA. Colangiopancreatografía retrógrada endoscópica asistida por enteroscopia de doble balón en un paciente con gastrectomía total y reconstrucción en Y-de-Roux: reporte de caso. Rev Colomb Gastroenterol. 2022;37(4):459-65. doi: 10.22516/25007440.844.

Ricardo-Ramírez AM, Vélez-Lara FJ, Ricardo-Ramírez AM, Vélez-Lara FJ. Colangiopancreatografía retrógrada endoscópica transgástrica dirigida por endosonografía en una paciente con baipás gástrico. Reporte del primer caso local. Rev Colomb Gastroenterol. 2023;38(4):497-503. doi: 10.22516/25007440.1008.

Krutsri C, Kida M, Yamauchi H, Iwai T, Imaizumi H, Koizumi W. Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy. World J Gastroenterol. 2019;25(26):3313-33. doi: 10.3748/wjg.v25.i26.3313.

Gangwani MK, Aziz M, Haghbin H, Iqbal A, Dillard J, Dahiya DS, et al. Comparing EUS-directed Transgastric ERCP (EDGE) Versus Laparoscopic-Assisted ERCP Versus Enteroscopic ERCP: A Network Meta-analysis. J Clin Gastroenterol. 2024;58(2):110. doi: 10.1097/MCG.0000000000001949.

Kedia P, Sharaiha RZ, Kumta NA, Kahaleh M. Internal EUS-directed transgastric ERCP (EDGE): game over. Gastroenterology. 2014;147(3):566-8. doi: 10.1053/j. gastro.2014.05.045.

Antonini F, Rizzo GEM, Vanella G, Fuccio L, Lisotti A, Bronswijk M, et al. Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography (EDGE): Techniques, Outcomes and Safety Profiles. J Clin Med. 2025;14(16):5675. doi: 10.3390/jcm14165675.

Su T, Chen T, Wang J, Feng Y, Wang R, Zhao S. EndoscopicDirected Trans-Gastric Retrograde Cholangiopancreatography in Patients With Roux-en-Y gastric Bypasses: A MetaAnalysis. J Clin Gastroenterol. 2023;57(9):871-8. doi: 10.1097/ MCG.0000000000001864.

Khara HS, Parvataneni S, Park S, Choi J, Kothari TH, Kothari ST. Review of ERCP Techniques in Roux-en-Y Gastric Bypass Patients: Highlight on the Novel EUS-Directed Transgastric ERCP (EGDE) Technique. Curr Gastroenterol Rep. 2021;23(7):10. doi: 10.1007/s11894-021-00808-3.

Chhabra P, On W, Paranandi B, Huggett MT, Robson N, Wright M, et al. Initial United Kingdom experience of endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography. Ann Hepato-Biliary-Pancreat Surg. 2022;26(4):318-24. doi: 10.14701/ahbps.22-019.

Prakash S, Elmunzer BJ, Forster EM, Cote GA, Moran RA. Endoscopic ultrasound-directed transgastric ERCP (EDGE): a systematic review describing the outcomes, adverse events, and knowledge gaps. Endoscopy. 2022;54(1):52-61. doi: 10.1055/a-1376-2394.

Ichkhanian Y, Jovani M. Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy. Curr Opin Gastroenterol. 2023;39(5):348. doi: 10.1097/ MOG.0000000000000965.

Deliwala SS, Mohan BP, Yarra P, Khan SR, Chandan S, Ramai D, et al. Efficacy & safety of EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) in Roux-en-Y gastric bypass anatomy: a systematic review & meta-analysis. Surg Endosc. 2023;37(6):4144-58. doi: 10.1007/s00464-023- 09926-7.