Succesful EDGE Procedure in UMC, First in Texas

Last Halloween while at home with her family, a patient who wishes to remain anonymous was waiting for trick or treaters to ring her doorbell.  Suddenly she felt a tremendous pain in her stomach sending her to the floor.

“The pain was so horrible,” she said, “I told my niece to help me get in my car and drive me to University Medical Center. Once at Emergency, she was diagnosed with stones in her biliary tract. Usually, it is a normal procedure to remove these stones, but the attending physicians were surprised to discover this patient had had Gastric Bypass Surgery. 

Gastric Bypass Surgery has become an increasingly popular treatment option for people struggling with obesity. In Gastric Bypass Surgery, a small pouch is created from the patient's stomach. This pouch is then connected to the small intestine to allow the digestive process to occur. But what happens if the patient develops gall bladder stones? Dr. Antonio Mendoza-Ladd, Gastroenterologist at University Medical Center found himself in this situation.

"This patient came to UMC because she was having gall bladder issues," said Dr. Mendoza-Ladd. "She had a stone in her biliary tract and the physician who wanted to treat her initially tried to do a procedure we normally do to remove gall stones, but," he adds, "when they went into her stomach they realized she had what we call a Roux-En-Y Gastric Bypass. And that kind of procedure makes it a little more challenging to remove the stones in her biliary tract." 

 

Because the patient now has an altered digestive system, gastroenterologists could not reach her biliary tract through endoscopy. “In the past the only way to access this disconnected stomach was through an open surgical procedure where the patient goes into the Operating Room and the surgeons help us reach the biliary tract with surgical equipment,” said Dr. Mendoza-Ladd.

Thanks to a new endoscopic procedure called Endoscopic Ultrasound Directed Trans Gastric ERCP (EDGE), Dr. Mendoza-Ladd was able to access the stomach without the need of going into the Operating Room.  “Basically what we are doing is connecting the excluded stomach to the stomach remnant that the patient is currently using to digest their food, and we are creating a tunnel with a stent that we place under endoscopic and sonographic guidance with an endoscopic procedure.”

After this tunnel is created to connect both parts of the stomach, they can go in and drain the gall bladder. 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.

University Medical Center of El Paso is the only hospital in the state of Texas to have done the EDGE procedure. Because of this, the patient did not have to undergo open surgery which saves recovery time and cost. The day after this procedure, she was able to eat soft food and liquids.

“I’m very thankful to have met Dr. Mendoza-Ladd,” she said. “He took away my pain and there was no need for surgery. Another one of my concerns was that I could gain weight again. Thanks to Dr. Mendoza-Ladd and UMC's Center of Excellence for Diagnostic and Advanced Endoscopy, UMC is the first hospital in the state of Texas to successfully have treated this condition using the EDGE procedure.