The University of Toledo Translation Journal of Medical Sciences 
Hospital Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e2 

Efficacy and Safety of EUS-directed 
Transgastric ERCP (EDGE) vs 
Laparoscopic-Assisted ERCP: A Systematic 
Review and Meta-Analysis 

Manesh Kumar Gangwani, MD1*, Hossein Haghbin, MD1, Fnu Priyanka, MD1, Yousaf Hadi, MD1, Dushyant 
Singh Dahiya, MD1, Faisal Kamal, MD1, Wade Lee-Smith, MLS2, Ali Nawras, MD3, Muhammad Aziz, MD3, 
Douglas G Adler, MD4

1Division of Hospital Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Division of Gastroenterology and Hepatology, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 
3Department of University Libraries, The University of Toledo, Toledo, OH 43614 
4Director of Therapeutic Endoscopy and Director of Gastroenterology Fellowship 
Training Program University of Utah, School of Medicine, Salt Lake City, UT 84132 

*Corresponding author: manesh.gangwani@utoledo.edu

Published: 05 May 2023 

Background: The altered anatomy in Roux-en-Y gastric bypass (RYGB) makes conventional 
Endoscopic retrograde cholangiopancreatography (ERCP) a technically challenging procedure. EUS-
directed Transgastric ERCP (EDGE) and Laparoscopic-Assisted ERCP (LA-ERCP) are alternative 
modalities used with comparable efficacy and adverse events in such patients. We conducted a meta-
analysis comparing EDGE and LA-ERCP to assess the efficacy and safety in patients with RYGB.  

Methods: We conducted a comprehensive literature search from inception through July 7th, 2022 on 
MEDLINE, EMBASE, Cochrane Register of Controlled Trials, and Web of Science database using the 
core concepts of “EDGE” and “LA-ERCP”. We excluded case reports, case series (<10 patients) and 
review articles. Relative risk (RR) was calculated when comparing dichotomous variables while mean 
difference (MD) was calculated for continuous outcomes. A 95% confidence interval (CI) and p-values 
(<0.05 considered significant) were also generated.  

Results: The search strategy yielded a total of 55 articles. We finalized 4 studies with total 192 patients 
(75 EDGE and 117 LA-ERCP). The rates of technical success were not significantly different for LA-
ERCP and EDGE (RR= 0.994, CI: 0.939 – 1.051, P= 0.830, I2= 0%) Similarly, no difference in adverse 
events were noted between the two groups (RR= 1.216, CI: 0.561-2.634, P= 0.620, I2= 10.67%). Shorter 
procedure time was noted for EDGE compared to LA-ERCP group (MD= 91.53 mins, CI: 69.911 – 
113.157, P<0.001 I2= 8.32%).  

https://dx.doi.org/10.46570/utjms.vol11-2023-745 

https://dx.doi.org/10.46570/utjms.vol11-2023-745
mailto:manesh.gangwani@utoledo.edu


https://dx.doi.org/10.46570/utjms.vol11-2023-745 UTJMS 11(1):e1-e2 

https://dx.doi.org/10.46570/utjms.vol11-2023-745 2 ©2023 UTJMS 

Conclusion: EDGE and LA-ERCP are comparable in terms of efficacy and safety. In addition, EDGE 
has overall lower procedural time. Our study suggests EDGE should be considered as a first-line therapy 
if expertise available. 

https://dx.doi.org/10.46570/utjms.vol11-2023-745
https://dx.doi.org/10.46570/utjms.vol11-2023-745