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Overview

Ercp: Treatment, Procedure, Cost and Side Effects

What is the treatment?

ERCP is a procedure used to examine the tubes that drain the liver, gallbladder and pancreas. Other diagnostic tests like abdominal ultrasound, CT scan or MRI cannot provide the kind of information that ERCP does. A flexible, lighted scope (endoscope) is used to produce x ray pictures. It is generally used to remove or crush gallstones, open the entry of ducts into bowel, take tissue samples, drain blocked areas, check persistent abdominal pains or jaundice and stretch out narrow segments.

How is the treatment done?

First of all, a medication will be given to relax or sedate you. A mouth guard will be attached in your mouth to protect your teeth. Your throat will be numbed by spraying a medication. After the sedative take effect, you will be asked to lie down on your left side and an intravenous line will be placed in your arm. An endoscope will then be inserted in your mouth. You should not feel any pain or discomfort. Neither should you have too much memory of this procedure. The ducts that lead to the pancreas and gallbladder will be inserted with a thin tube, which is passed through the endoscope. The thin tube has a light and camera at the end. X rays are taken by some special dyes that will be injected in these ducts. You may have to stay for 1-2 hours in the hospital until the effect of sedative wears off.

Who is eligible for the treatment? (When is the treatment done?)

If your doctor is not able to identify your problem with other diagnostic tests like abdominal ultrasound, CT scan or MRI; he may ask you to go for ERCP. Also, ERCP will be used if your doctor needs to see detailed images of the tubes that drain the liver, gallbladder and pancreas.

Who is not eligible for the treatment?

Most troubles can be diagnosed using other diagnostic tests like abdominal ultrasound, CT scan or MRI. There is no need to go for ERCP.

Are there any side effects?

You may have sore throat for a few days. You may also experience some bloating or gas for about 24 hours after procedure. The drugs provided during the treatment may have adverse effects due to which you may have to stay in the hospital for longer. Do not worry; the effects will wear off soon.

What are the post-treatment guidelines?

You should not drive immediately after the test. Ask someone to drive you home. Avoid lifting heavy weights for about 48 hours after the procedure. Consuming acetaminophen or using a heating pad will help in relieving the pain. Make sure that you drink fluids and have light meals after the treatment.

How long does it take to recover?

You may feel slight discomfort for 24-48 hours. You can resume your daily routine soon after the procedure while taking a few precautions.

What is the price of the treatment in India?

The cost of ERCP is between ₹15000 and ₹35000 depending on the area that is to be examined.

Are the results of the treatment permanent?

The results of this diagnostic test are permanent and can be treated accordingly.

What are the alternatives to the treatment?

There are no alternatives to this treatment.

Safety: Treatment Effectiveness: Medium Timeliness: High Relative Risk: Medium Side Effects: Low Time For Recovery: High Price Range:

Rs 15,000 - Rs 35,000

Popular Health Tips

Bile Duct Obstruction: Types, Causes and Symptoms

MBBS,MD, DM
Gastroenterologist, Hubli
Bile Duct Obstruction: Types, Causes and Symptoms

Obstruction of the bile duct is characterized by the blockage of the bile duct. The function of the bile ducts is to transport bile to your small intestine. The bile is excreted in order to digest fats from the food. 
There are two types of bile ducts in the body: 

  1. Intrahepatic ducts: These ducts are small tube like structures that carry the bile to extrahepatic ducts
  2. Extrahepatic ducts: Extrahepatic ducts are two ducts that descend from the liver into the body's small intestine

Causes:

The bile comprises of waste products, bile salts and cholesterol. The liver secretes bile which flows through the bile ducts and is stored in the gallbladder. If the bile ducts are blocked then the bile accumulates in the liver and can lead to jaundice.

Certain causes of this particular condition are mentioned below

  1. Bile duct obstruction may result from gallstones
  2. If you have inflammation in your bile ducts
  3. Narrowing of the bile ducts
  4. Enlargement of the lymph nodes
  5. Bile duct tumors
  6. Tumors in the pancreas
  7. Various infections such as hepatitis
  8. Liver complications such as cirrhosis
  9. Various parasites may lead to bile obstruction
  10. Inflammation of the pancreas
  11. If you have weak immune systems, then it may lead to infections that may result in bile duct obstructions

Symptoms:
The symptoms are: 

  1. You may experience yellowish skin
  2. You may have symptoms of fever and vomiting
  3. Abdominal pain especially in the upper part
  4. Stools may be light colored
  5. You may pass urine that is dark in color

Treatment:
The various treatment options for obstruction of the bile duct are surgeries that remove the blockage. Often ERCP ( (Endoscopic Retrograde Cholangio Pancreatography) is a process which is used for removal of stone from bileduct. You may prevent it by consuming a lot of fiber in your diet. Make lifestyle changes such as exercising on a regular basis and eating healthy.

In case you have a concern or query you can always consult an expert & get answers to your questions!

3527 people found this helpful

Endoscopic Retrograde Cholangiopancreatography (ERCP) - Know How It Can Help!

Fellowship In Colorectal Surgery, DNB - Surgical Gastroenterology, Fellowship In Minimal Access Surgery, Fellowship In HPB Surgery, Membership of the Royal College of Surgeons (MRCS), MS - General Surgery, MBBS
Gastroenterologist, Bangalore
Endoscopic Retrograde Cholangiopancreatography (ERCP) - Know How It Can Help!

Sometimes, when it comes to problems in the abdominal area, an ultrasound is not clear enough for a diagnosis. In such cases, an Endoscopic Retrograde Cholangiopancreatography (ERCP) may be performed. This procedure gives the doctor a clear view of the duodenum, bile duct, pancreatic ducts, gallbladder and papilla of Vater.

This procedure is usually performed under intravenous sedation without general anesthesia. This procedure involves the use of a duodenoscope, which can be described as a thin, long, flexible tube with a camera at one end. It also has a fiber optic bundle that transmits lights to the camera and a chip to transmit video images to a TV screen.

This is inserted through the patient’s mouth and sent down the throat through the food pipe to the stomach and duodenum while the patient is lying on his or her back. The air pipe is left undisturbed so as to not interfere with the patient’s breathing. Since the patient is not under general anesthesia, he or she can move and turn according to the doctor’s needs. The papilla of Vater is a small nipple like structure with an opening to the bile duct and pancreatic duct. Once this has been identified, a small plastic catheter is passed through the duodenoscope into the bile duct or pancreatic duct through the papilla. Dye is then injected into the area and X-rays are taken of the bile ducts and pancreatic duct. In cases where a biopsy is needed, other instruments can also be passed through the endoscope. Plastic or metal stents can also be passed through this to relieve obstructions in the bile ducts and pancreatic ducts.

ERCP can be used to diagnose and treat a number of conditions in the liver, bile ducts, gall bladder, pancreas and papilla of Vater. These include:

  1. Blockage of the bile duct by gallstones, cancer, scars, tumors or compression from adjacent organs.
  2. Jaundice due to an obstructed bile duct. This can also cause light stools and dark urine.
  3. Persistent upper abdominal pain
  4. Unexplained weight loss and loss of appetite
  5. Diagnosing a Dysfunctioning Sphincter of Oddi within the Papilla of Vater

ERCP can also be used to confirm pancreatic cancer and cancer of the bile duct. Once the diagnosis is confirmed, the doctors can customize treatment according to the patient’s needs. In case you have a concern or query you can always consult an expert & get answers to your questions!

3348 people found this helpful

Bile Duct Obstruction - All You Need To Know About It!

MS - Surgery, MAMS, Senior Residency , MBBS, Fellow IAGES
Surgical Gastroenterologist, Delhi
Bile Duct Obstruction - All You Need To Know About It!

Obstruction of the bile duct is characterized by the blockage of the bile duct. The function of the bile ducts is to transport bile to your small intestine. The bile is excreted in order to digest fats from the food. 

There are two types of bile ducts in the body

  1. Intrahepatic ducts: These ducts are small tube like structures that carry the bile to extrahepatic ducts
  2. Extrahepatic ducts: Extrahepatic ducts are two ducts that descend from the liver into the body's small intestine

Causes
The bile comprises of waste products, bile salts and cholesterol. The liver excretes bile which flows through the bile ducts and is stored in the gallbladder. If the bile ducts are blocked then the bile accumulates in the liver and can lead to jaundice.

Certain causes of this particular condition are mentioned below
1. Bile duct obstruction may result from gallstones
2. If you have inflammation in your bile ducts
3. Narrowing of the bile ducts
4. Enlargement of the lymph nodes
5. Bile duct tumors
6. Tumors in the pancreas
7. Various infections such as hepatitis
8. Liver complications such as cirrhosis

9. Various parasites may lead to bile obstruction
10. Inflammation of the pancreas
11. If you have weak immune systems, then it may lead to infections that may result in bile duct obstructions

The symptoms are
1. You may experience yellowish skin
2. You may have symptoms of fever and vomiting
3. Abdominal pain especially in the upper part
4. Stools may be light colored
5. You may pass urine that is dark in color


Treatment
The various treatment options for obstruction of the bile duct are surgeries that remove the blockage. Other treatment options are an ERCP (Endoscopic retrograde cholangiopancreatography) and a cholecystectomy which is the process of removal of the gallbladder. ERCP is another procedure that is used to get rid of gallstones from the gallbladder. You may prevent it by consuming a lot of fiber in your diet. Make lifestyle changes such as exercising on a regular basis and eating healthy. If you wish to discuss about any specific problem, you can consult a gastroenterologist.

2869 people found this helpful

Understanding Jaundice (Kamala)

M.D. (Ayurved), D.H.M, CHSE
Ayurveda, Jamnagar
Understanding Jaundice (Kamala)

Jaundice (also known as icterus) is a yellowish pigmentation of the skin, the conjunctival membranes over the sclera (whites of the eyes), and other mucous membranes caused by hyperbilirubinemia (increased levels of bilirubin in the blood). This hyperbilirubinemia subsequently causes increased levels of bilirubin in the extracellular fluid. Concentration of bilirubin in blood plasma does not normally exceed 1 mg/dl (gt 17 x00b5 mol/l). A concentration higher than 1.8 mg/dl (gt 30 x00b5 mol/l) leads to jaundice. This is a brief presentation on jaundice and its ayurvedic management.

Jaundice, also known as icterus is a disease caused due to the dysfunction of the liver. It is the most common of all liver disorders that results from an obstruction in the bile duct or the loss of the bile producing liver cells. Jaundice refers to the yellowing of skin and whites of the eyes caused by the high level of pigment bilirubin in the body. Bile is a vital digestive fluid that is essential for proper nutrition. It is unable to function properly and filtering and elimination of toxins from your system is affected.

Jaundice is caused mainly by the dysfunctional liver or other liver diseases. In tropical countries jaundice is more likely to happen because of the extreme nature of summer heat and digestive difficulties that it causes. Chronic digestive disorders like bowels inflammatory syndromes, gastric problems also play bigger roles in causing the disease. In relation to these internal causes jaundice can be of various types. Apart from this hepatitis virus can cause some major types of jaundice which can be potential life threats. Obstructive jaundice is another type of jaundice which is caused by obstruction caused in the liver function to relieve the bilirubin from the body. Pregnancy related jaundice and jaundice at child birth are other types of jaundice which is more common in pregnant women. Before introducing some of the major types of jaundice, for a better clinical understanding of the disease let us take a look at the basic process which causes jaundice.

Causes, incidence, and risk factors:
Every day, a small number of red blood cells in your body die, and are replaced by new ones. The liver removes the old blood cells, forming bilirubin. The liver helps break down bilirubin so that it can be removed by the body in the stool. This waste product is called bilirubin and when liver cannot perform its assigned function of relieving this waste product from our organic process the higher amount of presence of this chemical substance in the blood is felt and this is how the jaundice occurs. All major types of jaundice can have different areas of reasoning for the malfunction of the production process and relieving process of bilirubin, but the basic facts related with the bilirubin and its effects are all same in all minor or major types of jaundice

When too much bilirubin builds up in the body, jaundice may result.

Jaundice is caused due to following causes:
Obstruction of the bile ducts (by infection, tumor or gallstones)
Viral hepatitis (hepatitis a, hepatitis b, hepatitis c, hepatitis d, and hepatitis e)
Drug-induced cholestasis (bile pools in the gallbladder because of the effects of drugs)
Drug-induced hepatitis (hepatitis triggered by medications, including erythromycin sulfa drugs, antidepressants, anti-cancer drugs, aldomet, rifampin, steroids, chlorpropamide, tolbutamide, oral contraceptives, testosterone, propylthiouracil)
Biliary stricture
Alcoholic liver disease (alcoholic cirrhosis)
Pancreatic carcinoma (cancer of the pancreas)
Primary biliary cirrhosis
Ischemic hepatocellular jaundice (jaundice caused by inadequate oxygen or inadequate blood flow to the liver)
Intrahepatic cholestasis of pregnancy (bile pools in the gallbladder because of the pressure in the abdomen with pregnancy)
Haemolytic anemia
Congenital disorders of bilirubin metabolism (gilbert’s syndrome, dubin-johnson syndrome, rotor’s syndrome)
Chronic active hepatitis
Autoimmune hepatitis
Malaria


Jaundice is often a sign of a problem with the liver, gallbladder, or pancreas. Infections, use of certain drugs, cancer, blood disorders, gallstones, birth defects and a number of other medical conditions can lead to jaundice.

Clinical symptoms:
Jaundice may appear suddenly or develop slowly over time. Common symptoms of jaundice commonly include:


Yellow skin and the white part of the eyes (sclera) -- when jaundice is more severe, these areas may look brown 
Yellow color inside the mouth
Dark or brown-colored urine
Pale or clay-colored stools

Other symptoms depend on the disorder causing the jaundice:
Cancers may produce no symptoms, or there may be fatigue, weight loss, or other symptoms

Hepatitis may produce nausea, vomiting, fatigue, or other symptoms.

Differential diagnosis:
When a pathological process interferes with the normal functioning of the metabolism and excretion of bilirubin just described, jaundice may be the result. Jaundice is classified into three categories, depending on which part of the physiological mechanism the pathology affects.

Pre-hepatic jaundice: it is caused by anything which causes an increased rate of hemolysis (breakdown of red blood cells).

Laboratory findings include:
Urine: no bilirubin present, urobilinogen gt; 2 units (i.e. hemolytic anemia causes increased heme metabolism; exception: infants where gut flora has not developed).
Serum: increased unconjugated bilirubin.
Kernicterus is associated with increased unconjugated bilirubin.

Hepatocellular jaundice: it can be caused by acute or chronic hepatitis, hepatotoxicity, cirrhosis, drug induced hepatitis and alcoholic liver disease.

Laboratory findings depend on the cause of jaundice, include:
Urine: conjugated bilirubin present, urobilirubin gt; 2 units but variable (except in children). Kernicterus is a condition not associated with increased conjugated bilirubin.
Plasma protein show characteristic changes.
Plasma albumin level is low but plasma globulins are raised due to an increased formation of antibodies.

Post-hepatic jaundice: it is also called obstructive jaundice, is caused by an interruption to the drainage of bile in the biliary system. The most common causes are gallstones in the common bile duct, and pancreatic cancer in the head of the pancreas. Also, a group of parasites known as" liver flukes" can live in the common bile duct, causing obstructive jaundice.

The presence of pale stools and dark urine suggests an obstructive or post-hepatic cause as normal feces get their color from bile pigments. However, although pale stools and dark urine is a feature of biliary obstruction, they can occur in many intra-hepatic illnesses and are therefore not a reliable clinical feature to distinguish obstruction from hepatic causes of jaundice. Patients also can present with elevated serum cholesterol, and often complain of severe itching or" pruritus" because of the deposition of bile salts.

Signs and tests:
No single test can differentiate between various classifications of jaundice. A combination of liver function tests is essential to arrive at a diagnosis.

Other tests vary, but may include:
Hepatitis virus panel to look for infection of the liver
Liver function tests to determine how well the liver is working
Complete blood count to check for low blood count or anemia
Abdominal ultrasound
Abdominal ct scan
Endoscopic retrograde cholangiopancreatography (ercp)
Percutaneous transhepatic cholangiogram (ptca)
Liver biopsy
Cholesterol level
Prothrombin time


Ayurvedic approach:
In the ayurvedic perspectrive jaundice (kamala) is a complaint of the pitta region of the body, which denotes a build up of toxins in an intestinal area that is causing an in-balance in the overall dosha. You need to expel such toxins to rebalance the immune system and yourself. All the great indian laureates viz. Acharaya charaka, sushruta and vagbhatta have described the yakrita roga (liver diseases). Acharaya charaka has mentioned a detailed description of kamala roga in connection with liver disease. He has given details of nidan, samprapti, rupa, bheda, sadhyasadhayata and chikitsa karma. The concept of kamala in ayurveda kayam malyati iti kamala. i.e. The whole body becomes dirty because of accumulation of pitta in the body which refers to accumulation of bilirubin in this context. Kamala produces various signs and symptoms as haridra netra (yellow discoloration of conjunctiva), haridra twaka (yellow colour of skin), haridra nakha (yellow nails), bheka varna (frog like body color), daha (burning sensation), ajirna (indigestion), daurbalaya (weakness), kshudhanasha (anorexia) etc.

Management:
Since liver is the largest organ and main site of metabolism and detoxification, the diet should be easily digestible during this condition. So ayurvedic treatment contains such medicines which will facilitate removal of waste substances from the gut and kidney.

The treatment of kamala (jaundice) must start with purgation. The basic theory is that no burden be placed on the liver and for that, a daily purgative is recommended. A diuretic may also be administered to encourage the flow of urine, which will expel most of the bile from the system this helps to remove the toxins accumulated in the liver and the rest of the body. Strong purgatives are avoided. Oral medicines and rasayana treatments are also given to the patient. Strong purgatives are avoided.

Ayurvedic treatments for jaundice will aim to rectify the pitta imbalance and eliminate the toxins accumulated in the human system. Elimination of toxins is done through the panchakarma treatments that begin with an oil massage followed by mild emesis and purgation with bitter herbs.

Medicines used:
Regular intake of avipattikar churna about one- teaspoonful twice a day with hot water.
Arogyavardhani vati 2-2 tablets regularly with hot water twice a day.
Punarnava mandoor, 1 tab thice daily for 2 to 3 weeks.
Navrayas loh can also be given in the dose of 125mg thrice daily.
Daily consumption of triphala powder (10gm) soaked in water overnight. (equivalent to lactulose)
Regular intake of guduchi juice 10gm twice or thrice a day.
Daily intake of neem juice is also useful for jaundice
Rohitakyadi, punarnava, phalatrikyadi kwath, dhatri lauha etc. May also be used.

Some routine home remedies:
Mix 1 teaspoon of roasted barley powder to 1 cup of water. Add 1 teaspoon of honey to it and have this twice a day.
Add 1 teaspoon paste of basil leaves to a cup of radish juice. Have this juice twice a day for 15-20 days.
Have a cup of sugarcane juice with teaspoon of basil leaves paste twice a day. Juice should be prepared in hygienic conditions so as to avoid contamination from dust or other substances


Pathya-apathya (do's don'ts):
Avoid non-vegetarian foods at least till the effects of the jaundice last on the skin. Do not take even heavy vegetarian foods. The reason is that the liver needs to produce more bile to digest these heavy foodstuffs and this could alleviate the pigmentation of the skin.

Completely restrict your intake of junk food such as chocolate, cakes, pastries, potato chips, ice-creams, colas and other aerated drinks, etc.
Always drink water that is filtered or boiled. Do not drink raw milk.
Do not eat sea foods especially oysters, unless you are sure they have come from a reliable source.
Take simple food for the first three days of the jaundice affliction. Have a meal of porridge, especially rice gruel (kanji). You can flavor it with jaggery syrup or honey.
There must be a complete abstinence of salt as it is a mineral and requires a difficult digestion process.
Do not give cereals and pulses to the patient as they cause inflammation in the liver. Grapes, black soya beans, nuts, sweet potatoes are the fruits that are beneficial in jaundice.
Vegetable salad of tomato, carrot, radish and its leaves, and two-three slices of lemon are very good for health and very effective in curing jaundice in a natural way.
It is advised for the patient suffering with jaundice to take proper rest and drink fruit juices.
Bitter vegetables like bitter gourd and the bitter variety of drumsticks are beneficial to the jaundice patient.
Alcohol is very harmful to the jaundice patient. It can complicate the disease with fatal consequences. Hence say a strict no to alcohol.

5 people found this helpful

Popular Questions & Answers

I want to go for gallbladder Stone removal by Endoscopic Retrograde Cholangiopancreatography (ERCP). Let me know if its available with doctor or hospital.

FIAGES, FMAS, MS - General Surgery
General Surgeon, Pune
Gallbladder stones cannot be removed by ERCP only by laparoscopy. And its the it is gallbladder that is removed. Only duct stones can be removed by ERCP as of today.

I was suffering from jaundice. MRCP shows obstruction (sluge) and am advice ERCP. Your suggestion please.

BHMS, Diploma in Dermatology
Homeopath, Hyderabad
In adults, jaundice itself usually isn't treated. But your doctor will treat the condition that's causing it. If you have acute viral hepatitis, jaundice will go away on its own as the liver begins to heal. If a blocked bile duct is to blame, your doctor may suggest surgery to open it.
1 person found this helpful

My mother diagnosed gallbladder in the month of February 13,2018, and gave it for biosphy and the report shows bile duct cancer and hepatic metastasis. And now Dr. advice me to go for ercp. So, sir How long it will take for ercp. And will you please advice me more?

MBBS, M.S. General Surgery, M.R.C.S. England, M.Ch. Surgical Oncology, DNB Surgical Oncology, FEBS Surgical Oncology, DNB General Surgery, MNAMS, FMAS, FIAGES, FAIS, FICS, FEBS Breast Surgery, FACS, Fellowship IFHNOS & MSKCC USA, Fellowship in breast and oncplastic Surgery
Oncologist, Mumbai
ERCP is a procedure where by a scope is inserted into the duodenum and the bile duct and pancreatic duct is visualised. If need be, they can insert a plastic or metal stent depending upon the prognosis of the gall bladder cancer. Metal stent usually lasts for a few months but is cheaper, while self expanding metal stent lasts for 6mths to 2 years, but is expensive. ERCP is sometimes associated with complications like cholangitis, pancreatitis, and rarely perforation or bleeding. Feel free to contact me directly if you want to share your reports or discuss this further.
1 person found this helpful

Hi, I am 29 years old male and I have few stones in my Gallbladder approx. 10 mm, the cbd stones have been removed by ERCP and doctors are saying I should get my Gallbladder removed, prescribed Ursocol 450 mg for 15 days. I don't have much pain now after ERCP, how can I proceed? Is removal of Gallbladder the only way?

M.B.S.(HOMEO), MD - Homeopathy
Homeopath, Visakhapatnam
Some of the common Homeopathic medicines for gall bladder stones include Calcaria carbonica, Chelidonium, Phosphorus, Lycopodium clavatum, Nux vomica, China sulphuricum, Berberis vulgaris, Thuja occidentalis.
1 person found this helpful

I am 75 years old female have gastric problem from last 2 years; after taking log treatments and ERCP with EPT gas problem still same.

MBBS
General Physician, Hyderabad
hi! Medicines are not advisable to u If you have BP or sugar or heard disease or all 3 then gas problem will b there Avoid spicy food Go for a mild walk if u can Eat very little Don't skip meals Go for a heart check Thank u.

Table of Content

What is the treatment?
How is the treatment done?
Who is eligible for the treatment? (When is the treatment done?)
Who is not eligible for the treatment?
Are there any side effects?
What are the post-treatment guidelines?
How long does it take to recover?
What is the price of the treatment in India?
Are the results of the treatment permanent?
What are the alternatives to the treatment?
Play video
Role Of Endoscopic Ultrasound (EUS)
Hello Everybody!

I am Dr. Kunal Das and I am the principal consultant, department of gastroenterology, endoscopy. I am an expert on endoscopic ultrasound and today will talk about endoscopic ultrasound and its role in various diseases. Endoscopic ultrasound is a new tool which is combining 2 powerful procedures endoscopy and ultrasound. Endoscopic ultrasound was discovered 20 years ago where it was mostly used as the research tool. Endoscopic ultrasound plays a very important role in GI interventions.

Endoscopic ultrasound is basically an endoscope which is of 2 types. Radial and linear scope. The radial scope is one which is more rounded in corrector. It helps to diagnose various diseases like stones, GI. The 2nd type of scope is linear scope in which the plain of endoscopic ultrasound towards the axis of the scope and the advantage of the linear endoscope is that it can be used to with fine needle aspiration and GI interventions. This is used in various diseases. Endoscopic ultrasound is of great utility in the diagnosis of bile duct stones, pancreatic, adenocarcinoma. With this kind of scope these are the most important causes utilizing the end staging of upper GI.

It is the most important scope and diagnostic ability for pancreatic diseases. With newer techniques we can do pancreatic fine needle aspiration, fine needle biopsy which helps us in diagnosis of pancreatic cancers and hence, we can start chemotherapy. Also, there are newer techniques in endoscopic guidance for GI interventions. In angiotherapy, we use endoscopic ultrasound as a guide. We can do fine needle injections of chemotherapy of radiofrequency ablation of pancreatic cancers. Also, newer techniques, US techniques gastroenterostomy, where US guidance use to make a cannal between the stomach and the GI. The gallbladder is accessed from the GI tract and we put in a metallic strength between the gallbladder.

So, in those cases it has been found that it is of great usage instead of gallbladder drainage has been coming out in a great way. So, we find that endoscopic ultrasound is only a research tool. It is important in all of the GI centres so because of its utility diagnostic and therapeutic usage at this time. We also find that in certain cases where there is the mismatch or ERCP which cannot be done. Endoscopic ultrasound is a very important tool in the management of upper GI, like pancreatic cancers, pancreatic adenocarcinoma, chemotherapy. And today it is the essential tool for the management of GI in our practice.

Thank You.
Play video
Symptoms and Treatments Of Gallbladder Stones
Here are some treatments and symptoms of gall bladder stones

Symptoms and Treatments of Gallbladder Stones
Dear friends. I m Dr. Manish Kumar Gupta. I m a Consultant Laparoscopic and Robotic Surgeon in Sir Ganga Ram Hospital.
I have my own clinic with the name New life clinic at Indirapuram, Ghaziabad.
Today, friends, I ll be talking about gall bladder stone which is a very common problem in North India.
The gall bladder is basically a pear shaped organ which is attached to the liver and the bile which is formed in the liver gets stored in the gall bladder which is later goes in to the intestine, and get mixed with the food to cause digestion of the food.
Whenever the component of the bile like cholesterol or bile pigment increases there is formation of gall bladder stones.
The symptoms of gall bladder stones are basically distension of abdomen after having heavy meals or discomfort or sometimes patient can have pain in the right side of the upper abdomen or which can radiate to the back and shoulder.
Sometimes, these gall bladder stones can be silent stones, and they lie in the gall bladder without causing any symptoms but if these stones are in patients having diabetes or if these stones are very large more than 2 cm in size then, the treatment is required.
The diagnosis of gall bladder stone is very simple. By a simple ultrasound abdomen, one can be easily diagnosed whether the patient is having a gall bladder stone or not and it is almost a confirmatory diagnosis. One does not need a very special investigation or test to get diagnosed these gall bladder stones.
The treatment for gall bladder stones is basically a surgery.
There s nothing like, you can t do anything to prevent gall bladder stones to form but yes, if you eat less oily or less fatty meals, the symptoms get relieved to some extent.
As I told you that the treatment is surgery. Nowadays, there is no big cut in the tummy to take out the gall bladder but what we do nowadays is a laparoscopic surgery.
In laparoscopic surgery, we make three or four pencil size holes in the abdomen and through these holes we operate. Through one hole, we put a cylinder like camera inside and by two or three ports, we put our instruments inside and get these gall bladder removed from the abdomen through a 10 mm port.
Nowadays, this type of surgery is basically a day care surgery and one can come to the hospital and get operated and can be discharged on the very same day if it s an uncomplicated gall bladder.
Gall bladder can cause complications also other than these symptoms and if the stone gets slipped down and gets inducted in a common bile duct which is a channel which joins the gall bladder to the intestine and if the stone gets inducted in common bile duct, then, one has to take out that stone endoscopically through ERCP and then after that one has to go for gall bladder stone removal.
So, it is like a two stage procedure. So, one should not wait to get all these complications to occur because , if the stone gets inducted in the CVD then, the chances of jaundice, chances of acute pancreatitis can occur which can be dreaded complication .
So, friends I have told you about the gall bladder stones and if you have such problems, if you have gall bladder stones even though it is asymptotic or you have symptoms you should go to a surgeon or a physician who can guide you.

You can tell you what need to be done or if you want to meet me you can come to me at Sir Ganga Ram Hospital or at my clinic which is in Indirapuram with the name New life clinic or you can talk to me through Lybrate, you can chat with me, you can text me at the lybrate.com and I will be available 24 hours to you.
Thank you friends! Thank you!
Having issues? Consult a doctor for medical advice