ERCP-CBD (Bile Duct) stone, pitt nali pathari

ERCP-CBD (Bile Duct) stone, pitt nali pathari

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Sometimes stones are formed in the bile duct that needs to be removed.

The bile duct carries bile from our liver to the intestine that helps in the digestion of the food.

The gall bladder is also connected to the bile duct, and sometimes stone in the gall bladder slip into the bile duct.

If the patient has stone in the bile duct, either it is silent or some patients develop jaundice, abdominal pain and fever.

In such patients, when we conduct liver functions test, the amounts of bilirubin, serum, alkaline phosphatase and SGOT or SGPT are increased.

We do an ultrasound to confirm stones in the bile duct.

If the stones are not visible in the ultrasound and we suspect that there are stones in the bile duct then we do a special test called endoscopic ultrasound.

Once the stone is confirmed we can easily remove it by ERCP. ERCP stands for Endoscopic Retrograde Cholangiopancreatography.

ERCP is an endoscopic technique that does not require any cuts or surgery anywhere in the body.

For this we use a special endoscope, known as duodenoscope, is used.

The patient is completely anaesthetized before endoscopy.

Here you can see that he is completely unconscious and we are inserting the endoscope in his mouth.

First of all, we do endoscopic ultrasound, endoscopic ultrasound is an advanced test specially used to acess bile duct duct stone.

As you can see, there is a small stone in the bile duct which we shall remove through with ERCP.

We can see the papilla inside the endoscopy image.

The papilla are the openings of the bile duct inside the intestine.

First, we pass the catheter through the papilla.

Here we can see that we are passing the catheter through papilla into the bile duct.

Once the catheter enters the bile duct, we cut the opening of papilla.

Here we can see that we are cutting out the opening of papilla with electropority.

After cutting the papilla we insert a balloon into the papilla, after inserting the balloon we pull that balloon.

The baloon takes the stone out of the bile duct with it.

We can see the stone which is left in the small intestine.

We don’t take it out through of the mouth.

This stone comes out of the body through the stool.

After removing the stone we leave a stint in the tube.

We can see that the blue stint being inserted in the bile duct.

The purpose of the stint is to prevent infection.

After gall bladder surgery the stint can be removed after four to six weeks.

Mostly ERCP is a safe technique but in some patients, it can create complications as well.

The main complications are Pancreatitis, Bleeding, Perforation.

The pancreatic tube is also near the bile duct.

If the wire goes deep into the pancreas, if left in place, the patient may develop pancreatitis.

Such patients suffer from abdominal pain after ERCP or the patient may also vomit.

The value of Amylase and lipase increases.

After ERCP, if the patient develops pancreatitis, it is normally a mild pancreatitis that takes three to four days to resolve.

In some patients, there may be bleeding while cutting the papilla which we can be controlled through injection or clip.

Some patient may also require surgery.

We have to cut the papilla very carefully if the papilla is cut too much it may cause perforation or leakage.

After a hole or leak, the patient may have to stay in the hospital for up to three weeks and some people may even need surgery.

If care is taken, CBD stones can be easily removed by ERCP.

If someone has stones in CBD then such patients do not worry. We can easily remove such stones through ERCP.