A comparison of clinical outcomes and cost utility among laparoscopy, enteroscopy, and temporary gastric access-assisted
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and Other Interventional Techniques
A comparison of clinical outcomes and cost utility among laparoscopy, enteroscopy, and temporary gastric access‑assisted ERCP in patients with Roux‑en‑Y gastric bypass anatomy Thomas J. Wang1,3 · Pedro Cortes3,4 · Pichamol Jirapinyo2,3 · Christopher C. Thompson2,3 · Marvin Ryou2,3 Received: 10 June 2020 / Accepted: 25 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background and aims Gastric Access Temporary for Endoscopy (GATE), also known as EUS-Directed Trangastric ERCP (EDGE), has demonstrated advantages over device-assisted enteroscopy (DAE) and laparoscopic-assisted ERCP (LA-ERCP) for patients with Roux-en-Y gastric bypass (RYGB) anatomy. We aimed to directly compare clinical outcomes and cost utility among the three ERCP modalities. Methods Patients with RYGB anatomy who had DAE, LA-ERCP, or GATE from 2009 to 2019 at 2 tertiary centers were included in our review. We measured outcomes in three areas: success rate, post-procedural adverse events (AEs) and hospitalization, and cost utility per Medicare/Medicaid insurance payments. Results Cohort Total 130 patients (70 underwent DAE, 42 LA-ERCP, and 18 GATE). Success rate DAE was successful in 59% of patients, compared to success rates of 98 and 100% for LA-ERCP and GATE, respectively (p
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