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Gastric bypass surgery has become an increasingly popular treatment option for the some 30 percent of Americans struggling with obesity. However, many gastric bypass patients struggle with side effects from the procedure, which are difficult to treat due to the patients’ surgically-altered digestive tract. In order to more effectively treat these conditions, NewYork-Presbyterian/Weill Cornell Medical Center developed EUS-Directed Transgastric ERCP (EDGE), the first minimally invasive procedure to treat pancreaticobiliary diseases in gastric bypass patients.

“With the EDGE procedure, patients with gallstones and other causes of bile duct obstruction can usually be treated without the need for open surgery, which improves recovery time and greatly increases their comfort,” said Dr. Michel Kahaleh, chief of endoscopy in the division of gastroenterology and hepatology at NewYork-Presbyterian/Weill Cornell Medical Center and a professor of medicine at Weill Cornell Medical College, who developed the EDGE procedure. “We’re proud to be the first hospital to successfully treat gastric bypass patients using this technique.”

Altered Anatomy Presents Treatment Challenges

In gastric bypass surgery, a small pouch is created from the patient’s stomach, with the remainder of the stomach cut off from the passage of food. The pouch is then connected to the small intestine to allow the digestive process to occur. Due to the rapid weight loss caused by the procedure, gallstones and bile duct obstructions are common side effects in gastric bypass patients. Nearly 50 percent of patients who undergo the most common gastric bypass procedure develop gallstones and 25 percent may have their gallbladder removed.

“When surgeons perform gastric bypass, they alter the anatomy to ensure that patients lose weight,” said Dr. Kahaleh. “But the reconfigured stomach and intestines makes it difficult to access the bile duct and gallbladder through minimally invasive procedures.”

EDGE Offers an Effective Solution

Dr. Kahaleh developed EDGE based on his extensive experience using the AXIOS, a lumen apposing metal stent, which is used to treat conditions such as pancreatic pseudocysts and bile duct obstructions. Using AXIOS, he connects the accessible pouch to the excluded stomach. While the stent is in place, a specialized endoscope can extract the gallstone and drain the pancreas or the bile duct internally without using surgery. During that process the bypass is temporarily rendered ineffective. Once the lumen apposing metal stent is removed and the pouch closed a few weeks later, the bypass efficiency is restored. Since April 2014, five gastric bypass patients with gallstones or obstructed bile ducts have been successfully treated with EDGE without experiencing weight gain. The patients did not have to undergo open surgery, which saves recovery time and costs.

NewYork-Presbyterian/Weill Cornell Medical Center

NewYork-Presbyterian/Weill Cornell Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and Weill Cornell Medical College, the medical school of Cornell University. NewYork-Presbyterian/Weill Cornell provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, education, research and community service. Weill Cornell physician-scientists have been responsible for many medical advances — including the development of the Pap test for cervical cancer; the synthesis of penicillin; the first successful embryo-biopsy pregnancy and birth in the U.S.; the first clinical trial for gene therapy for Parkinson’s disease; the first indication of bone marrow’s critical role in tumor growth; and, most recently, the world’s first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. NewYork-Presbyterian Hospital also comprises NewYork-Presbyterian/Columbia University Medical Center, NewYork-Presbyterian/Morgan Stanley Children’s Hospital, NewYork-Presbyterian/Westchester Division, NewYork-Presbyterian/The Allen Hospital, and NewYork-Presbyterian/Lower Manhattan Hospital. The hospital is also closely affiliated with NewYork-Presbyterian/Lawrence Hospital in Bronxville. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area, according to U.S. News & World Report, and consistently named to the magazine’s Honor Roll of best hospitals in the nation. Weill Cornell Medical College is the first U.S. medical college to offer a medical degree overseas and maintains a strong global presence in Austria, Brazil, Haiti, Tanzania, Turkey and Qatar. For more information, visit www.nyp.org and weill.cornell.edu.