P2293 - Comparing Endoscopic Ultrasound-Directed Transgastric ERCP, Enteroscopy-Assisted ERCP, and Laparoscopic-Assisted ERCP in Roux-en-Y Gastric Bypass: A Network Meta-Analysis

Manesh Kumar Gangwani, MD¹, Hossein Haghbin, MD², Muhammad Aziz, MD¹, Amna Iqbal, MD¹, Julia Dillard, ¹, Dushyant Singh. Dahiya, MD³, Umar Hayat, MD⁴, Yusuf Nawras, ¹, Wade M.. Lee-Smith, MLS¹, Faisal Kamal, MD⁵, Sumant Inamdar, MD⁶, Douglas G. Adler, MD^7
1University of Toledo, Toledo, OH; ²Ascension Providence Hospital, Southfield, MI; ³University of Kansas School of Medicine, Kansas City, KS; ⁴Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA; ⁵Thomas Jefferson Health, Philadephia, PA; ⁶University of Arkansas, Toledo, OH; ⁷Center for Advanced Therapeutic (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, CO

Introduction: Managing cholelithiasis in post-Roux-en-Y gastric bypass surgery is challenging due to altered anatomy. Through direct and network meta-analysis, our study aimed to compare the technical success rates, adverse events, and procedural time with three approaches: endoscopic ultrasound-directed transgastric ERCP (EDGE), enteroscopy-assisted ERCP (E-ERCP), and laparoscopic-assisted ERCP (LA-ERCP).

Methods: The search was performed using 5 databases. We conducted a direct head-to-head comparator and network meta-analysis of all available groups. A comparison of interventions was conducted using network meta-analysis using the random-effects model. A p-value < 0.05 was considered statistically significant.

Results: 16 studies were included in the final analysis. The technical success rates were comparable between EDGE and LA-ERCP (OR: 0.768, CI: 0.196-3.006, p = 0.704, I2 = 14.13%). However, a statistically significant difference in technical success was observed favoring EDGE over E-ERCP (OR: 4.507, CI: 2.201-9.266, p < 0.001, I2 = 0.08%). Similarly, there was a statistical difference in technical success between E-ERCP and LA-ERCP, favoring LA-ERCP (OR: 4.507, CI: 2.201-9.266, p < 0.001, I2 = 0.08%). These outcomes were consistent on network meta-analysis.

There was no statistical difference between adverse events of EDGE vs LA-ERCP (OR: 0.720, CI: 0.305-1.696, p = 0.452, I2 = 21.18%), EDGE vs E-ERCP (OR: 0.902, CI: 0.364-2.234, p = 0.824, I2 = 42.67%) and LA-ERCP vs E-ERCP groups (OR: 0.661, CI: 0.417-1.047, p = 0.924, I2 = 0%). Results are consistent on network meta-analysis.

Evaluating procedure time, EDGE was shorter than E-ERCP (MD: -31 minutes, 95% CI: -40.748--21.217, p < 0.001, I2 = 19.89%) E-ERCP was shorter than LA-ERCP (MD: -44.567 minutes, 95% CI: -76.018--13.116, p = 0.005, I2 = 0%). Furthermore, EDGE had a significant time advantage over LA-ERCP (MD: -78.145 minutes, 95% CI: -104.882--51.407, p < 0.001, I2 = 0%). Similarly, on network meta-analysis, there was a statistical difference among the three groups with the EDGE procedure requiring the shortest time, followed by E-ERCP and LA-ERCP.



Discussion: EDGE and LA-ERCP outperformed E-ERCP in technical success. Adverse events do not significantly differ among the three groups. Furthermore, EDGE demonstrates a shorter duration compared to LA-ERCP, making it a potentially more desirable procedure. Based on these findings, we recommend considering EDGE as the preferred procedural modality, if expertise are available.



Disclosures:


Manesh Kumar Gangwani, MD¹, Hossein Haghbin, MD², Muhammad Aziz, MD¹, Amna Iqbal, MD¹, Julia Dillard, ¹, Dushyant Singh. Dahiya, MD³, Umar Hayat, MD⁴, Yusuf Nawras, ¹, Wade M.. Lee-Smith, MLS¹, Faisal Kamal, MD⁵, Sumant Inamdar, MD⁶, Douglas G. Adler, MD⁷. P2293 - Comparing Endoscopic Ultrasound-Directed Transgastric ERCP, Enteroscopy-Assisted ERCP, and Laparoscopic-Assisted ERCP in Roux-en-Y Gastric Bypass: A Network Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.