Post written by Antonio Mendoza Ladd, MD, from the Department of Medicine, Division of Gastroenterology, Texas Tech University Health Sciences Center at El Paso, El Paso, Texas, USA.

This is a case of a patient with impending ascending cholangitis secondary to choledocolithiasis in the setting of a Roux-en-Y anatomy. Given her surgical anatomy, we discussed the options of laparoscopy-assisted ERCP vs EDGE. After careful discussion of the risks and benefits of both options, she opted for EDGE in an attempt to avoid surgery.

We believe this video is important because it highlights one of the many therapeutic modalities that the lumen-apposing metal stent (LAMS) has made possible. EDGE provides a minimally invasive alternative to a treat a problem that otherwise would require either a surgical intervention or a balloon-assisted procedure (options that are not always readily available). However, surgical backup is paramount when performing EDGE.

We encountered mild difficulty puncturing the excluded stomach with the hot AXIOS delivery system. Therefore, we opted for the cold system assisted by catheter dilation of the tract. Using a wire to guide the stent deployment system was critical in order to avoid making multiple punctures in the gastric pouch and the excluded stomach.

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