Table 3.

Complications of endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE).

Complication	Author (year)	Number of patients	Details regarding complication
Bleeding	Bukhari et al. (2018)	1	During gastrogastrostomy creation, managed with transfusion only
	Wang et al. (2019)	1	Following LAMS exchange for a double-pigtail stent, treated with epinephrine and LAMS to tamponade bleeding
	Kedia et al. (2019)	1	No further clarification
	de Benito Sanz et al. (2020)	1	Post-sphincterotomy bleeding, managed endoscopically
	Kochhar et al. (2020)	2	Sphincterotomy-related bleeding, managed with balloon tamponade
	Tyberg et al. (2020)	2	One case managed with endoscopic hemoclips, the other with a bridging stent to tamponade the bleed
Perforation	Kedia et al. (2019)	1	Due to malfunction of the catheter delivery system during LAMS deployment process, managed with immediate surgical repair
	de Benito Sanz et al. (2020)	1	Duodenal perforation closed by OTS clips
	Tyberg et al. (2020)	1	Jejunal perforation during duodenoscope advancement, managed endoscopically
Persistent fistula	Bukhari et al. (2018)	1	Persistent leak identified on upper GI series 6 weeks after closure was attempted with endoscopic suture, managed with OTS clip closure and confirmed on follow-up upper GI series
	Crismale et al. (2016)	1	EDGE, initially performed for cholangitis, was complicated by LAMS dislodgement requiring esophageal stent placement; presented 10 months post-procedure with 20 lb weight gain; stent removed using grasping forceps, APC to denude gastrogastric fistula before an endoscopic suturing device used to place a running suture, then oversewn with an interrupted stitch
Stent malposition	Tyberg et al. (2020)	2	Flange deployed outside target lesion, managed with bridging esophageal FCSEMS
	James et al. (2020)	6	Rescue procedures with placement of esophageal FCSEMS in four patients
Stent migration (intraprocedural)	Bukhari et al. (2018)	2	During ERCP stage of EDGE, stent repositioned across fistula in one patient and FCSEMS placed in the other
	Duloy et al. (2019)	1	Stent migration during scope withdrawal, resulting in stent migration into peritoneum, managed with placement of a second larger LAMS to connect the gastric pouch and remnant stomach
	Kedia et al. (2019)	3	Managed with bridging esophageal FCSEMS, mineral oil used to lubricate the shaft of the duodenoscope to prevent further occurrences
	Wang et al. (2019)	2	During ERC Pstage of single-session EDGE, endoscopically corrected
	de Benito Sanz et al. (2020)	4	Two occurred during single-session EDGE and two occurred during deferred ERCP; three cases were managed with LAMS relocation and one by OTS clip closure
	Krafft et al. (2020)	6	Five occurred during single-session EDGE and one during shortened-interval EDGE; incomplete LAMS dislodgement in four patients (managed with bridging esophageal FCSEMS deployed OTW) and complete LAMS dislodgement in two patients (managed with bridging esophageal FCSEMS, one deployed via NOTES and one OTW)
Stent migration (postprocedural)	Simmons-Linares et al. (2018)	1	LAMS migration into the excluded stomach while waiting for maturation, managed by passing a wire through the fistula to the excluded stomach and TTS placement of an 18-mm × 6-cm FCSEMS, with ERCP then successfully performed
	Kochhar et al. (2020)	1	LAMS dislodgement after ERCP, managed by removing the original LAMS and stenting the fistula with a new LAMS
Abdominal pain	Krafft et al. (2020)	2	Post-procedural abdominal pain requiring prolongation of hospitalization, occurring in one patient with complete LAMS dislodgement requiring NOTES and in another with aborted ERCP because of duo denoscope angulation

LAMS, lumen apposing metal stent; OTS, over the scope; GI, gastrointestinal; APC, argon plasma coagulation; FCSEMS, fully covered self-expanding metal stent; ERCP, endoscopic retrograde cholangiopancreatography; OTW, over the guidewire; NOTES, natural orifice transluminal endoscopic surgery; TTS, through the scope.