{
  "abstract": "Aims Endoscopic ultrasound-directed transgastric ERCP (EDGE) has emerged as an important modality for biliary access in patients with altered upper gastrointestinal anatomy, but data from real-world multicentre practice remains limited. This study reports outcomes of EDGE performed in 9 tertiary centres in the UK.Methods A retrospective analysis was conducted of consecutive EDGE procedures performed over 2024 - 2025. Data collected included demographics, indication, anaesthesia type, stent characteristics, anastomosis type, single or multiple stage, use of stent fixation, completion of the intended therapeutic outcome, subsequent fistula management and adverse events. Analysis was performed around outcomes comparing single vs multiple stage procedures.Results One hundred and three patients (median age 59 years; 18 males) were included. The indications were common bile duct stones (n=83), biliary mass/stricture (n=8), papillary stenosis (n=4), PEG insertion (n=3), bile leak (n=2), drainage procedure (n=2) and other (n=1). Sixty-one procedures were performed under general anaesthesia and 42 under conscious sedation. Technical success was achieved in 101/103 (98.1%) procedures with anastomoses being gastro-gastrostomy (89) and enterogastrostomy (12). Axios stents sized 15×10 mm and 20×10 mm were used in 5 and 96 procedures respectively. Thirty procedures were completed as single-stage (all under general anaesthesia), while 68 with available data were two-stage with a median interval of 14 days between the stages. 31 of the two-stage procedures were performed under general anaesthesia. Stent fixation clips were used in 36 procedures including 6 two-stage cases (24 OTSC and 11 standard clips), whereas 65 procedures were performed without clip fixation (all two-stage). Overall, the intended therapeutic outcome was achieved in 96/98 (97.95%) procedures. Table 1 shows the different outcomes comparing single stage to two-stage EDGE. During single stage there were 5/30 adverse events of which 4 were stent dislodgement (3 managed endoscopically) and 1 pancreatitis. During two-stage there were 7 adverse events of which 5 were stent dislodgement (4 were clinically relevant), 1 failed cannulation and 1 pancreatitis. Fistula follow up showed 56 closed spontaneously or had no closure (35 had a barium or endoscopy), 32 were not assessed, 13 had endoscopic closure and 2 were closed at surgically.Discussion In this multicentre series, EDGE demonstrated a high rate of technical and clinical success with acceptable adverse event rates. Most adverse events can be managed endoscopically and no difference was seen comparing number of stages or use of sedation/anaesthesia. The findings support EDGE as an effective modality for biliary and related interventions in patients with altered anatomy. More data concerning fistula follow up is needed.Abstract O32 Table 1Outcomes comparing single stage to two-stage EDGEProcedureSingle stageTwo-StagepN3068-Sedation:GA0:3037:31<0.0001Fixation clips30 6<0.0001Technical success29 (96.7%)67 (98.5%)0.52Therapeutic success29 (96.7%)67(98.5%)0.52Adverse event5 (16.7%)7 (10.3%)0.51",
  "authors": [
    {
      "affiliations": [
        "Freeman Hospital, Newcastle Upon Tyne, United Kingdom",
        "Freeman Hospital, Newcastle Upon Tyne, United Kingdom"
      ],
      "name": "Khalid Bashir"
    },
    {
      "affiliations": [
        "Freeman Hospital, Newcastle Upon Tyne, United Kingdom",
        "Freeman Hospital, Newcastle Upon Tyne, United Kingdom"
      ],
      "name": "Khurum Hakeem"
    },
    {
      "affiliations": [
        "Freeman Hospital, Newcastle Upon Tyne, United Kingdom",
        "Freeman Hospital, Newcastle Upon Tyne, United Kingdom"
      ],
      "name": "Eoin Keating"
    },
    {
      "affiliations": [
        "Guys and St Thomas’ Hospital, London, UK",
        "Freeman Hospital, Newcastle Upon Tyne, United Kingdom"
      ],
      "name": "Terry Wong"
    },
    {
      "affiliations": [
        "Hammersmith Hospital, London, UK",
        "Freeman Hospital, Newcastle Upon Tyne, United Kingdom"
      ],
      "name": "David Simon"
    },
    {
      "affiliations": [
        "Edinburgh Royal Infirmary, Edinburgh, UK",
        "Freeman Hospital, Newcastle Upon Tyne, United Kingdom"
      ],
      "name": "Grant Peddie"
    },
    {
      "affiliations": [
        "University Hospitals Southampton, Southampton, UK",
        "Freeman Hospital, Newcastle Upon Tyne, United Kingdom"
      ],
      "name": "Madison Shan"
    },
    {
      "affiliations": [
        "St James’ University Hospital, Leeds, UK",
        "Freeman Hospital, Newcastle Upon Tyne, United Kingdom"
      ],
      "name": "Mohamed Elseragy"
    },
    {
      "affiliations": [
        "Royal Free Hospital, London, UK",
        "Freeman Hospital, Newcastle Upon Tyne, United Kingdom"
      ],
      "name": "Aikaterini Mountaki"
    },
    {
      "affiliations": [
        "Royal Free Hospital, London, UK",
        "Freeman Hospital, Newcastle Upon Tyne, United Kingdom"
      ],
      "name": "Fawad Khattak"
    },
    {
      "affiliations": [
        "Wythenshawe Hospital, Manchester, UK",
        "Freeman Hospital, Newcastle Upon Tyne, United Kingdom"
      ],
      "name": "Mohamed Korani"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham, Birmingham, UK",
        "Freeman Hospital, Newcastle Upon Tyne, United Kingdom"
      ],
      "name": "Colme Forde"
    },
    {
      "affiliations": [
        "Freeman Hospital, Newcastle Upon Tyne, United Kingdom",
        "Freeman Hospital, Newcastle Upon Tyne, United Kingdom"
      ],
      "name": "Khurum Hakeem"
    }
  ],
  "title": "O32 Endoscopic ultrasound-directed transgastric interventions. Real world data from 9 tertiary centres in the UK",
  "uid": "d81c8e2b-081f-5bd0-b396-f7ceb27489ed"
}