Description of Event or Problem · 0
IT IS REPORTED IN THE LITERATURE TITLED ¿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,¿ PATIENTS EXPERIENCED ADVERSE EVENTS IN THREE STUDY GROUPS USING DIFFERENT OLYMPUS DEVICES. CASE WITH PATIENT IDENTIFIER (B)(6) REPORTS THE DAE GROUP AES (DEVICE: OLYMPUS SINGLE OR DOUBLE BALLOON DUODENOSCOPE-MODEL NOT SPECIFIED). CASE WITH PATIENT IDENTIFIER (B)(6) REPORTS THE LA-ERCP GROUP AES (DEVICE: OLYMPUS THERAPEUTIC DUODENOSCOPE-MODEL NOT SPECIFIED). CASE WITH PATIENT IDENTIFIER (B)(6) REPORTS THE GATE GROUP AES (DEVICE: GF-UCT180 OR TGF-UC180J). BACKGROUND AND AIMS: GASTRIC ACCESS TEMPORARY FOR ENDOSCOPY (GATE), ALSO KNOWN AS EUS-DIRECTED TRANSGASTRIC 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 METHOD: 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 <¿0.001). FOR DAE, 62% OF UNSUCCESSFUL CASES REQUIRED RESCUE THERAPY. ADVERSE EVENTS AND HOSPITALIZATION PATIENTS WHO UNDERWENT GATE HAD THE LOWEST RATE OF HOSPITALIZATION POST PROCEDURE (44% VS. 77% AND 100% FOR DAE AND LA-ERCP, RESPECTIVELY, P¿<¿0.01) AND SPENT THE LEAST AMOUNT OF TIME HOSPITALIZED (MEDIAN TIME 0 DAYS VS 2 AND 3 DAYS FOR DAE AND LA-ERCP, RESPECTIVELY, P¿<¿0.0001). GATE HAD LOWER AE RATES THAN LA-ERCP (6 VS 31%, P¿=¿0.046), AND BOTH HAD SIMILAR RATES TO DAE. COST UTILITY LA-ERCP CARRIED THE HIGHEST TOTAL PROCEDURAL AND HOSPITALIZATION COST PER MEDICARE/ MEDICAID INSURANCE PAYMENTS (MEDIAN PAYMENT DIFFERENCE OF $9.7 K VS GATE AND $7.9 K VS DAE, P¿<¿0.01 FOR BOTH). PROCEDURAL AND HOSPITALIZATION COSTS WERE SIMILAR BETWEEN GATE AND DAE (P¿=¿0.76). CONCLUSIONS: GATE IS A SAFE MODALITY FOR ERCP WITH HIGH SUCCESS RATES IN RYGB PATIENTS AND EXHIBITS THE LOWEST HOSPITALIZATION TIME AND RATE OF ADVERSE EVENTS WHEN COMPARED TO DAE AND LA-ERCP. GATE IS SIMILAR TO DAE FROM A COST UTILITY APPROACH, AND BOTH ARE LESS COSTLY THAN LA-ERCP. THIRTEEN PATIENTS IN THE LA-ERCP GROUP EXPERIENCED ADVERSE EVENTS (POST-ERCP PANCREATITIS [5], SEVERE ABDOMINAL PAIN AT GASTRIC ACCESS SITE [3], INFECTION AT ACCESS SITE [2], PELVIC ABSCESS [1], SEVERE ABDOMINAL PAIN, ETIOLOGY UNCLEAR [1], PARTIAL SMALL BOWEL OBSTRUCTION [1], AND DUODENAL BULB PERFORATION [1]). ONE PATIENT IN THIS STUDY GROUP REQUIRED OPEN LAPAROTOMY ERCP. THERE IS NO REPORT OF OLYMPUS DEVICE MALFUNCTION DESCRIBED IN THIS STUDY.