1. Which biliary and pancreatic diseases are suitable for duodenoscopic treatment?
(1) Various types of extrahepatic bile duct stones
(2) Acute obstructive purulent cholangitis, acute biliary pancreatitis, Tianjin Nankai Hospital Minimally Invasive Surgery Center Zou Fusheng
(3)Biliary ascariasis
(4) benign stenosis of the lower end of the common bile duct caused by stones or chronic inflammation
(5) Tumor of bile duct or head of pancreas, etc.
2. What are the advantages of endoscopic treatment of common bile duct stones?
Traditional surgery for common bile duct stones is inevitable because of the high trauma, high risk, complications, patient pain and long hospital stay. Many patients of advanced age or with multiple medical conditions and excessive obesity have obvious advantages of endoscopic treatment. Endoscopic treatment of common bile duct stones is a very mature technique that does not require general anesthesia, does not require dissection, and is as short as a gastroscopy. At present, endoscopic techniques are the preferred treatment for patients with common bile duct stones in developed countries, and are more effective and safer than surgical endoscopic stone extraction.
3. What are the main symptoms of common bile duct stones?
Common bile duct stones can cause abdominal pain, chills, fever, jaundice and other symptoms. It can cause acute cholangitis, bile duct stricture, bile duct obstruction, liver function damage, etc.
4. What are the serious consequences when stones block the bile duct?
Common bile duct stones can lead to a series of serious complications, such as acute purulent cholangitis, pancreatitis, obstructive jaundice, etc., with jaundice, chills, high fever, elevated white blood cells, and even toxic shock such as decreased blood pressure and delirium coma. In the past, surgical open-heart surgery was often required, with high risk and high mortality. In contrast, endoscopic drainage of the bile duct is less traumatic, safe, timely and effective.
Can all common bile duct stones be removed by endoscopy? What if they cannot be removed?
For large stones over 1.5cm in diameter, if it is difficult to remove them by endoscopy, mechanical lithotripsy or extracorporeal lithotripsy can be performed under duodenoscope to remove the stones by mesh basket after they are crushed; or if the stones are hard and cannot be crushed, nasobiliary drainage can be performed first and then a combined minimally invasive surgery can be performed to remove them.
6. What are the advantages of treating benign and malignant biliary strictures by duodenal stenting?
For benign bile duct strictures caused by repeated biliary surgery, endoscopic stenting is sometimes the only effective method; for malignant bile duct strictures caused by biliary or pancreatic tumors, where the patient is of advanced age and cannot tolerate anesthesia or surgery due to severe cardiopulmonary disease, endoscopic stenting provides a safe and effective method, and can even achieve better results than surgery.
7. What preparations should be made before endoscopic stone extraction treatment?
Doctors: Laboratory tests such as liver and kidney function, blood and urine amylase, bleeding and clotting time, and platelet count should be performed before surgery. In cases of obstructive jaundice or suspected bile duct obstruction or stone, body temperature and white blood cell count and classification should be noted. The patient and family should be explained in detail about the procedure of endoscopic lithotripsy before the operation to obtain the patient’s active cooperation, and the family should be informed of the possible complications during the operation. Ask the patient if he has a history of iodine allergy and do an iodine allergy test.
Patients: relax and get enough rest; fast from food and water 8 hours before the procedure; change into a hospital gown and wait for the examination and treatment.
8. What are the advantages and disadvantages of painless endoscopy?
Due to cultural and individual differences in patients’ tolerance of endoscopic operations, a significant number of patients may have anxiety and fear before surgery, and may even be afraid to undergo endoscopy and delay their condition.
Painless endoscopy (also known as conscious sedation) refers to the preoperative and intraoperative administration of moderate sedative and/or analgesic drugs for gastrointestinal endoscopy, so that the endoscopy can be completed without pain and anxiety. Compared with general endoscopy, painless endoscopy has the advantages of shortening the examination time, no tension before the examination, no pain during the examination, and quick recovery after the examination; the doctor can observe the subtle lesions of the gastrointestinal tract more carefully and perform minimally invasive endoscopic treatment more comfortably; painless endoscopy also reduces the side injuries caused by unconscious agitation of patients due to pain.
9. What is the difference between ERCP and MRI and CT?
ERCP can provide direct and clear images of the pancreatic and biliary ducts and has high diagnostic value for bile duct stones, bile duct tumors, bile duct strictures and pancreatic duct diseases. It can clearly show the size, number and stenosis range of lesions, and it not only has high diagnostic value, but also can be treated at the same time.
CT is a body scan of the human body with computer-controlled X-rays, and magnetic resonance imaging (MRI) is an imaging technique that uses the signals generated by the collection of magnetic resonance phenomena to reconstruct images. CT and MRI observe lesion sites from different angles, and they are both non-invasive means of examination.
10. What should I pay attention to in my diet after endoscopy?
Patients should fast for 24 hours and recheck the urinary amylase after the operation, after normal, they can eat liquid and gradually resume normal diet.
It is also very important to have a regular life, pay attention to the combination of work and rest, often participate in physical activities, eat breakfast on time, and avoid gaining weight as preventive measures. Drinking a glass of milk every night or eating a fried egg for breakfast can make the gallbladder contract and empty at regular intervals, reducing the time that bile stays in the gallbladder.