consent was obtained from all patients before the procedure. All patients were evaluated routinely with a contrast-enhanced computed tomography (CT) scan. A PQP was defined as a fluid collection in the pancreatic or peripancreatic area that had a well-defined wall and contained no solid debris or recognizable parenchymal necrosis. A convex linear-array echoendoscope were used. Once the PQP was identified, it was accessed using a 19-gauge needle (ECHO tip 19 G, Cook Medical), after a 0.035-inch guidewire was inserted into the pseudocyst via the FNA needle. After removal the needle, we used a needle knife inserted over the guidewire to create a bigger fistula. Finally, the gastric wall was dilated up to 15 mm using a wire- guided balloon and two pigtail plastic stents (7F and 4 cm) were deployed to facil- itate the drainage of PQP contents into the stomach. Technical success was defined as the proper positioning of two plastic stents with the echoendoscope either via a transgastric technique. Clinical success was defined as complete resolution or a decrease in size of the fluid collection to 2 cm or smaller on CT in association with resolution of symptoms at the 8-week outpatient follow-up evaluation. Results: 61 cases of PQP were analyzed, 20 of which were drained endoscopically guided by EUS and 41 surgically. Characteristics of patients are shown in Table 1. The clinical suc- cess of the endoscopic group was 90% and 92.6% for the surgical group, with a complication rate of 20% and 26.8% respectively, and a mortality rate of 0% and 2.4% for each group. These results showed no significant difference (Table 2). However, the hospital stay was lower for the group treated endoscopically (11.2 Æ 5.5 days) compared with 19.5 Æ 11.4 days in the surgical group with a P value of 0.024. Likewise, the cost was lower in the endoscopic drainage group with P !0.001. Conclusions: endoscopic treatment of PQP offers the same success, morbidity and mortality rate than surgical treatment but with fewer hospital day stay and with a lower cost. Characteristics of patients classified by treatments Variable Surgical treatment n [ 41 n (%) EUS-guided drainage n [ 20 n (%) P Value Female 14 (34) 8 (40) 0.65 Age, years 40,3 Æ 14,5 44,5 Æ 12,3 0.27 BMI 24,7 Æ 4,3 25,3 Æ 4,3 0.61 Comorbidities 24 (59) 13 (65) 0.62 Etiology of pancreatitis 0.27 Stones 15 (37) 7 (35) Alcohol 7 (17) 1 (5) Triglicerides 1 (2,4) 1 (5) Unspecified 18 (44) 11 (55) BMI: body mass index Clinical Success, days in-hospital, complication rates, and costs of treatment of pa- tients according to endoscopic treatment and surgical treatment. Variable Surgical treatment N [ 41 n (%) EUS-guided drainage N [ 20 n (%) P Value Clinical success 38 (92.6) 18 (90) 0.4 In-hospital, days 7.5 (2-30) 0 (0-10) !0.001 Intensive care unit, days 5,4 Æ 8,4 2 Æ 0 0.58 Costs, USD 7,855Æ 633 3141 Æ 1,732 !0.001 Complications 11 (26,8) 4 (20) 0.40 Recurrence 0 1 (5) 0.27 Mortality 1 (2,4) 0 (0) 0.67 Mo1368 Bypassing the Bypass: Endoscopic Ultrasound-Directed Transgastric ERCP (Edge) for Roux-En Y Anatomy Prashant Kedia*, Nikhil a. Kumta, Carlos M. Rondon Clavo, Jessica L. Widmer, Subha V. Sundararajan, Mark Cerefice, Monica Gaidhane, Reem Z. Sharaiha, Michel Kahaleh Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY Background: Patients with roux-en y gastric bypass (RYGB) present distinct chal- lenges for endoscopic retrograde cholangiopancreatography (ERCP). Success rates of deep enteroscopy-assisted ERCP (EA-ERCP) have been reported as low as 63%. Recently, percutaneous-assisted transprosthetic endoscopic therapy (PATENT) to perform antegrade ERCP in those patients have been described. This study reports a new endoscopic technique utilizing endoscopic ultrasound (EUS) to place a gas- trostomy tube into the excluded stomach through which antegrade ERCP can be performed. Methods: Six patients with RYGB anatomy and biliary obstruction requiring endoscopic intervention underwent EDGE at our institution between July 2013 - November 2013. All procedures were performed in two stages. The first stage of the procedure involved placement of a 16Fr percutaneous gastrostomy (PEG) into the excluded stomach using EUS-guidance. During the second stage, ERCP was performed in an antegrade fashion through the fashioned gastrostomy after replacement of the PEG with a transcutaneous fully-covered metal esophageal stent. Results: 6 patients (5 women) with RYGB anatomy underwent EDGE. Indications included choledocholi- thiasis (nZ5), biliary stricture (nZ1). EUS-guided access of the excluded remnant stomach was successful in all six patients (100%) (Table 1). Antegrade ERCP was suc- cessfully achieved in all six patients (100%) with a mean 5.8 days between the two stages (Table 2). The mean procedure time for each stage was 81 and 98.3 minutes. Two patients (33%) had localized PEG site infections that were managed with oral antibiotics. There were no adverse events related to ERCP including post-ERCP pancreatitis, perforation, or bleeding. Conclusions: EDGE is a feasible and safe tech- nique to perform in RYGB patients. The rates of post-ERCP pancreatitis are lower than those reported for EA-ERCP (0% vs. 15%). Given the high success rates of our recent experience, we suspect that this technique will provide a cost-effective, minimally invasive option for a common problem in a growing patient population. Table 1. Outcomes of EUS-assisted gastrostomy tube placement Patient EUS access of remnant stomach Clinical outcome Procedure time (mins) Sessions Adverse events Time between stages 1 Yes Unable to place gastrostomy tube due to decreased length of PEG needle, IR placed 16F gastrostomy tube into bypassed remnant 110 2 Localized PEG site infection 5 days 2 Yes 16F gastrostomy tube placed 42 1 Localized PEG site infection 3 days 3 Yes 16F gastrostomy tube placed 89 1 None 4 days 4 Yes 16F gastrostomy tube placed 86 1 None 7 days 5 Yes 16F gastrostomy tube placed 102 1 None 9 days 6 Yes 16F gastrostomy tube placed 57 1 None 7 days Table 2. Outcomes of second stage modified PATENT ERCP Patient Procedure Clinical outcome ERCP intervention Procedure time Sessions Adverse events 1 ERCP Success Sphincterotomy, brushings of biliary stricture, metal biliary stent placement 128 1 None 2 ERCP Success Sphincterotomy, stone removal, metal biliary stent placement 70 1 None 3 ERCP Success Sphincterotomy, plastic biliary stent placement 115 1 None 4 ERCP Success Sphincterotomy, stone removal, transcystic gallbladder stent, biopsy of ampullary stricture, metal biliary stent placement 72 1 None 5 ERCP Initial attempt: unsuccessful due to loss of wire access to bypassed stomach remnant Second attempt: success Sphincterotomy, stone removal, transcystic gallbladder stent, biopsy of ampullary stricture, metal biliary stent placement 107,118 2 None 6 ERCP Success Sphincterotomy, sludge extraction, metal biliary stent placement 78 1 None AB304 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5S : 2014 www.giejournal.org Abstracts