Pancreas and Liver/Bile Duct Procedures

Procedure Details

EUS –Endoscopic Ultrasound

EUS is an endoscopic procedure that combines standard endoscopy with ultrasound to obtain images of internal organs in the chest, abdomen and pelvis. EUS can be used to visualize the wall of the esophagus, stomach and colon/rectum in addition to allowing the visualization of adjacent structures such as the liver, pancreas, bile ducts and lymph nodes.
When combined with a procedure called fine-needle aspiration (FNA), EUS allows your doctor to sample (biopsy) fluid and/or tissue for analysis. EUS with FNA can be a minimally invasive alternative to exploratory surgery.
EUS techniques can also be used in certain therapeutic procedures such as the drainage of pancreatic pseudocysts or obstructed bile ducts.

ERCP –Endoscopic Retrograde Cholangio-Pancreatography

ERCP is a technique that combines the use of endoscopy and fluoroscopy (X-rays) to diagnose and treat certain diseases of the biliary or pancreatic ductal systems. ERCP is primarily performed by highly skilled and specialty trained gastroenterologists.
During ERCP your doctor will advance a special endoscope through your mouth, esophagus and stomach into the duodenum (first part of the small intestine). Following localization of the common drainage point of the pancreatic duct and bile duct, called the major papilla, a small catheter is advanced through the endoscope and into the ducts. Contrast material (dye) is then injected into the pancreatic or bile ducts and visualized using fluoroscopy.
ERCP is a well-tolerated procedure when performed by doctors who are specially trained and experienced in the technique. Although complications requiring hospitalization can occur, they are rare. These include pancreatitis (inflammation of the pancreas), infection, bowel perforation and bleeding.

ESWL –Exracorporeal Shock Wave Lithotripsy for Large Pancreatic Stones

Large stones that block the pancreatic duct can cause significant pain and negatively impact the quality of life. Although small stones in the main pancreatic duct can often be removed or treated endoscopically by ERCP, large stones may require additional treatment techniques.
ESWL is a safe and effective treatment for large pancreatic duct stones that are not amenable to endoscopic therapy alone. This adjunct treatment modality uses shock waves to fragment the stones allowing them to then be more easily removed from the pancreatic duct by ERCP. ESWL can significantly increase the success rate of nonsurgical treatment of chronic pancreatitis and pancreatic duct stones and significantly improve symptoms.

RFA-Radiofrequency Ablation of Bile Duct Tumors

RFA can be used in the bile ducts for the palliative treatment of bile duct cancer during ERCP.
RFA utilizes heat therapy that is applied via a special catheter that is advanced through the endoscope into the bile duct to destroy the tumor cells.
Bile duct tumor RFA has been shown to be effective in maintaining bile duct patency and prolonging life expectancy in patients with unresectable bile duct tumors.