Published on February 11, 2020

A new procedure at Silver Cross Hospital can help bariatric weight loss patients recover faster from biliary and pancreatic diseases. 

Dr. Kamran Ayub“One of the side effects of rapid weight loss is the development of common bile duct stones,” explains Dr. Kamran Ayub, gastroenterologist and Medical Director of the Advanced Endoscopy Center at Silver Cross Hospital. “These solid particles are formed from bile crystallization in the gallbladder and bile duct. They can cause pain, nausea, fever, sepsis and often require surgical removal in these patients.” 

Within the United States today, obesity has become an epidemic and is the most common reversible cause of death in the country. According to the American Society for Metabolic and Bariatric Surgery, over 250,000 bariatric weight loss surgeries are done in the United States every year. Weight loss surgery is considered one of the only effective ways to treat morbid obesity in some patients and can even solve other health issues such as hypertension and diabetes. 

In fact, Silver Cross Hospital is a regional leader in weight loss surgery, positively impacting the lives of more than 7,000 individuals since the program was introduced in the early 2000s. 

For patients who undergo bariatric bypass surgery, however, removing stones can be a challenge because the digestive tract is altered as a result of the surgery. But a new procedure at Silver Cross, the endoscopic ultrasound directed transgastric endoscopic retrograde cholangiopancreatography (ERCP), more commonly known as the EDGE procedure, offers a safe endoscopic alternative to surgery. This is a relatively new procedure and Dr. Ayub at Silver Cross Hospital was one of the first physicians in the country to offer the EDGE. 

How EDGE Works

Edge diagramDuring gastric bypass surgery, a small stomach pouch is created and then attached to the small intestine, essentially bypassing most of the stomach and the common bile duct. When gastric bypass patients develop common bile duct stones, doctors need to go through the pouch, into the small intestine and then back through the stomach in order to reach the common bile duct. This is a long and hazardous procedure with a moderate success rate. The alternative is surgery which requires incision and admission to the hospital. 

The EDGE procedure creates a shorter pathway to the common bile duct using an endoscope and is less invasive. 

“During the procedure, a stent is placed to create a pathway from the stomach pouch to the rest of the stomach and into the common bile duct, making for a shorter route to the stones,” Dr. Ayub adds. “Because of this, the patient is spared a surgery and instead, undergoes a less invasive procedure and experiences a quicker recovery.” 

The endoscopic procedure does not require external incisions. After the procedure, patients can often leave the hospital that same day or the following day. 

For more information about the EDGE procedure or other endoscopic procedures available at Silver Cross, visit silvercross.org. 

About Dr. Kamran Ayub

Dr. Kamran Ayub is considered an expert in advanced endoscopy including endoscopic ultrasound, ERCP, Confocal Laser Endomicroscopy and Endoscopic Submucosal Dissection (ESD) and Full Thickness Resection (EFTR). He has performed more than 60,000 procedures. He specializes in diseases of pancreas, bile duct, esophagus including gastroesophageal reflux and Barrett’s esophagus, and cancers of the digestive tract. Dr. Ayub has described new techniques of endoscopic ultrasound-guided nerve blocks and first described EUS-guided core biopsy of the liver. Dr. Ayub has trained numerous doctors in advanced endoscopy and has written and spoken extensively on these topics at national and international meetings.

Physicians on Silver Cross Hospital’s Medical Staff have expertise in their areas of practice to meet the needs of patients seeking their care. These physicians are independent practitioners on the Medical Staff and are not the agents or employees of Silver Cross Hospital. They treat patients based upon their independent medical judgment and they bill patients separately for their services.