Do you feel there is any difference between performing an ERCP with an EDGE together in a single session or separately in two sessions in a patient with Roux-en-Y anatomy?

Experts do both approaches - I think the minority will do EDGE (or GATE = gastric access temporary for endoscopy, a more inclusive term than EDGE, which is for ERCP only, although GATE only refers to gastric access) with ERCP in a single session as a routine, while more do the 2-step approach. Of course, if it's an emergency like cholangitis, you need to do a single-stage approach, but must secure the LAMS in place before going through to do EfRCP. Otherwise, for non-emergent indications, one can do two sessions, which is theoretically safer as the tract will have matured, although complications have occurred with the 2-session approach as well, and the studies do not suggest a significant difference in complications. Even with a single-stage approach, the patients need to come back for a second procedure to remove the LAMS (if sure the patient will not need further procedures through the LAMS), so especially for those who are less experienced with therapeutic EUS/ don't have access to suture, etc, the LAMS securely in place would suggest a 2-stage approach.