Internal EDGE (EUS-Directed transGastric ERCP) procedure

What is a Roux-en-Y Gastric Bypass?

Roux-en-y Gastric Bypass (RYGB) is the most popular and successful bariatric surgical procedure currently offered to treat obesity.   In this procedure, the stomach is cut into two parts. The upper pouch, which becomes the working stomach, can only hold about one ounce at the time of surgery. A cut is made in the section of the intestines called the jejunum, and this part of the intestines is connected to your new pouch. The Roux-en-Y gastric bypass is considered a combination restrictive and malabsorptive procedure, which is why it is so successful at achieving weight loss.

Why is performing ERCP challenging in RYGB patients?

It is not uncommon for RYGB patients to develop bile duct problems (such as stones or blockages).  Rapid weight loss from RYGB procedures can precipitate the formation of gallstones, which can cause bile duct problems. ERCP  is the easiest way to deal with these types of issues. However in RYGB anatomy conventional ERCP can no longer be performed because the original stomach and intestines cannot be accessed due to the changes made by the prior RYGB surgery.  To perform ERCP in these patients a combined surgical and endoscopic procedure should be performed in the operating room to give endoscopists the best chance at access to the bile ducts.  This is an invasive procedure that requires the coordination of two different medical teams and can result in significant recovery time for the patient.

What is the Internal EDGE procedure?

The EDGE procedure is a novel technique developed to perform ERCP in a completely endoscopic fashion in RYGB patients.  Because patients having undergone RYGB have had their intestines rearranged surgically for weight loss, a conventional ERCP is no longer possible.  Currently the standard of care is to perform a combined surgical and endoscopic procedure to access the bile duct.  Endoscopists can now avoid the surgical part of this procedure by using EUS  to temporarily reverse a patient’s bypass using a specially designed stent to allow for to performance of a conventional. When the need for ERCP is complete, the stent is removed and the bypass anatomy is restored via endoscopic suturing.  This is all performed completely from inside the body with and endoscope and can be performed on an outpatient basis.

Is the Internal EDGE procedure safe?

The EDGE procedure was first performed by Dr. Kedia and his mentor Dr. Michel Kahaleh in 2014 and thus is a very new technique.   Since then more EDGE procedures have been performed and emerging data shows that it is both effective and safe.  Early comparative studies of EDGE with laparoscopy-assisted ERCP that the EDGE procedure is just as effective and safe as surgery, but allows for shorter procedure times and length of stays in the hospital.

Who is a candidate for the EDGE procedure?

Patients with RYGB anatomy and clear evidence of bile duct disease that required endoscopic intervention may be candidates for the EDGE procedure.

Ready to Learn More?

Are you interested in learning more about the Internal EDGE procedure, or other treatment options? We invite you to contact us to learn more. Dr. Prashant Kedia is a therapeutic endoscopist and gastroenterologist serving patients in the Dallas-Fort Worth area and beyond. Call today to schedule an appointment at (214) 941-6891.

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