S2214 Efficacy and Safety of Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE) Among Early Career Advanced Gastroenterologists

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 2 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 woman, 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. Conclusion: 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.