A minimally invasive procedure for people who have had gastric bypass surgery that will allow a physician to diagnose tumors, remove gallstones or relieve any obstructions in the bile or pancreatic duct is now available at Hartford Hospital.
Known as the EDGE procedure [EUS directed trans-gastric ERCP], it was performed on a patient in May by gastroenterologist Vaibhav Mehendiratta, MD, at Hartford Hospital. The EDGE procedure involves placing a stent to connect the gastric pouch that was created during the bypass surgery to the so-called “excluded” portion of the stomach.
The EDGE procedure has been in use for a few years, says Dr. Mehendiratta, but wasn’t implemented at Hartford Hospital until they felt there was sufficient data to demonstrate safety and success.
It is a procedure specifically for people who have undergone gastric bypass and now have some sort of blockage. Gastric bypass recipients who might have a blockage cannot have a traditional endoscopic retrograde cholangiopancreatography (ERCP), a procedure used to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. Because a portion of their stomach has been disconnected from their digestive system, an ERCP isn’t easily feasible.
Various techniques have been developed to overcome the technical difficulties associated with performing an ERCP on patients who have had bariatric surgery. These include device-assisted ERCP or laparoscopic-assisted ERCP. Prior to using EDGE, those patients would usually have traditional laparoscopic surgery to gain access to the excluded stomach.
“Surgery would create a channel into the excluded stomach,” Mehendiratta explains. “It’s more invasive because it’s an external incision. It requires two different surgeons with two different teams.”
“EDGE is basically an ERCP with the help of an endoscopic ultrasound,” Mehendiratta says. The entire procedure is done through the patient’s mouth, requiring no incisions. The stent is secured between the gastric pouch and the excluded stomach, and then the ERCP can be performed.
“The patient will usually go home the next day,” Mehendiratta says. “This is a great procedure for us to be able to offer. The close collaboration between surgeons and interventional endoscopists is important to formulate a plan that is personalized to the needs of the individual patient.”