P0533 Gastric Access Temporary for Endoscopy (GATE): An Algorithmic Approach Towards LAMS-Assisted Temporary Reversal of Gastric Bypass Anatomy to Perform Foregut Procedures

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    *EMBARGOED All research presented at the 2018 ACG Annual Scientific Meeting and Postgraduate Course is strictly embargoed until Monday, October 8, 2018, at 8:00 am EDT.


    Thomas J. Wang, MD

    Thomas J. Wang, MD

    P0533 Gastric Access Temporary for Endoscopy (GATE): An Algorithmic Approach Towards LAMS-Assisted Temporary Reversal of Gastric Bypass Anatomy to Perform Foregut Procedures

    Author Insight from Thomas J. Wang, MD, Massachusetts General Hospital

    What’s new and important here?

    EUS-Directed trans-Gastric ERCP (EDGE) or Gastric Access Temporary for Endoscopy (GATE) is an emerging technique for performing ERCP in patients with Roux-en-Y gastric bypass (RYGB) anatomy. The novelty of the procedure involves the temporary reversal of the gastric bypass through the use of a lumen-apposing metal stent (LAMS) to allow for passage of a conventional duodenoscope. Adverse events, although low, have been reported in a small percentage of patients, with the most concerning being stent dislodgement and failure of access tract closure, which may lead to persistent fistulae and thereby reversal of the RYGB. The latter is a serious concern and may be one of the reasons EDGE/GATE has not been systematically adopted across hospitals in the United States. To address these issues, we propose a detailed algorithmic approach to EDGE/GATE, including identification of ideal locations for LAMS deployment, optimal timing of ERCP or other foregut procedures, and the use of double pigtail plastic stents after LAMS removal to facilitate access tract closure. At our center we believe this algorithmic approach has minimized risk of adverse events and led to 100% success in access tract closure on follow-up. However larger multi-center studies are required to confirm these encouraging findings.

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    Author Contact
    Thomas J. Wang, MD, Massachusetts General Hospital
    Twang16@partners.org


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