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: s 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.Eleven patients in the dae group experienced adverse events (post-ercp pancreatitis [7], septic shock [2], infected hematoma [1], biliary leak [1]) treated with la-ercp, interventional radiology (ir), or repeat dae.There is no report of olympus device malfunction described in this study.
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