Gallstones can be defined as small lumps or stones that are a collection of hard solid material that form in the gallbladder or bile duct (this is a pear shaped sac, situated below the liver). The medical term for gallstones is 'cholelithiasis'. Bile is a liquid that is secreted by the liver which is important for digesting food in the intestine. It is stored in the gallbladder until the body requires it. This liquid travels to the small intestine via the gallbladder or bile duct, to help digestion whenever needed.
Bile is composed of water, salts, cholesterol, fats, bile salts and bilirubin. When there is an imbalance in these chemicals in the gallbladder, stones are formed. These stones can be small crystals like that of a grain of sand, or can be of bigger size too. These stones do not particularly cause symptoms or pain in each case, but in certain cases they may cause pain and discomfort. There are surgical and non surgical procedures to get rid of gallstones, one of which is ERCP.
Causes and Symptoms
Before we study the treatment procedure, let us take a quick view on the causes and symptoms for gallstones. There are two types of gallstones, cholesterol and pigment gallstones. As mentioned before, stones are mainly caused by the imbalance in bile. However, there can be other factors causing stones too, like in pregnant women - because of too much estrogen, others factors like birth control pills and hormone therapy, rapid weight loss, diabetes, liver disease, hereditary, and also people with a high fat diet. It is more common in women than in men.
These are mostly called silent stones, as they never move or cause pain. A majority of the people will not be aware of the gallstone until a test is conducted, for example, an ultrasound, X-ray, etc. There may be symptoms after a long period of time in some cases. They are caused as the gallstone will obstruct the bile ducts. The major symptoms are, belching and flatulence, intolerance to foods high in fats, dyspepsia, feeling nauseous and restless, jaundice, sweating and severe abdominal pain that does not soothe even after taking painkillers.
Diagnosis and Treatment
A typical gallstone will be detected in tests. The doctor will take a detailed report of the symptoms and medical history. Ultrasound, blood and urine tests may also be required to check if the stones have caused any infection or other problems. The treatment will be as basic as following a healthy diet, and drugs to dissolve the gallstone, lithotripsy (shock wave therapy that breaks the stones in tiny pieces which later are dissolved with medicines) or complex as surgical treatments like stone surgery or gallbladder removal.
ERCP and Gallstone Removal
In gallstones, a condition called Choledocholithiasis appears when the gallstone is stuck or present in the common bile duct. This condition may damage the liver cells and cause other risks. This needs to be treated by cholecystectomy and / or ERCP. The full form of ERCP is Endoscopic Retrograde Cholangio Pancreatography .
It is one of the procedures to primarily diagnose and remove the stones. It enables the doctor to check the problems in the liver, bile duct, pancreas and gallbladder. It uses X-rays and an endoscope (a flexible lighted scope), it is a long and flexible tube (flexible enough to be directed to move along as many bends in the stomach and intestine), and uses a thin wire with a chip attached at the tip of the instrument that transmits video images onto the screen. The procedure is as follows:
- This instrument is inserted in the mouth and then slowly moved down through the esophagus, stomach and duodenum (first portion of the small intestine) till it reaches the intersection where the pancreatic ducts and the bile ducts (gallbladder ducts) enter the duodenum.
- Through this endoscope, the physician can see the inside of the duodenum and stomach, and inject dyes in the pancreas so that the X-ray can detect them.
- The doctor will ask you to lie on the left side in the X-ray room. A medicine and sedative will be given to numb the throat and help you relax during the procedure.
- Once it reaches the intersection, the doctor will ask you to lie down flat on your stomach, and inject the dye for the X-ray.
- The X-rays will detect if there is any gallstone or if the bile ducts are narrowed.
- If a gallstone is detected, the physician may insert instruments through the same endoscope to remove the stone or obstruction. This saves the patient from undergoing any surgery.
Before and After ERCP Procedures
The procedure can take from around 30 minutes to 2 hours. It depends on the condition of the gallstone and complications. Before the test, your stomach and duodenum must be empty to ensure a safe and successful procedure. So you will have to avoid food consumption for at least 6 - 8 hours before the test. During the test, the drug given to numb the throat may be slightly bitter, and you may feel like you have a swollen throat and tongue.
Because of the tube, a slight difficulty will be experienced, but that is a fake sensation. The tube gives enough space to breathe even when inserted in the throat. A mild cramping in the abdomen may be felt, and you may feel nauseous and bloated. After the test, the drugs may make you sleepy with heavy eyelids, a dry mouth, blurred vision, a bloated feeling and gas, even hours after the test can be experienced. You will need to stay in the hospital for a few hours after the test, or even stay for a day if the gallstone was removed.
Certain risks are also involved in ERCP. Mainly, inflammation of the pancreas, abnormal heart rhythm, a puncture of the esophagus, infection, bleeding in case if the pancreas or bile ducts were enlarged. You must talk to the physician about all possible risks, and also if you have any allergies, to avoid future risks.
This covers all about ERCP to remove gallstones. Prevention is better than cure, and we all agree with that the most. So save the risks for gallstone removal, and take proper care to maintain a healthy abdomen.