Member Comments are provided by individuals and reflect their personal opinions only. Under NO circumstances should you act on any advice or opinion posted in this forum.  ALWAYS check with your personal physician before taking any action regarding your health! MedHelp International and our partners, sponsors and affiliates have no obligation to monitor any comments posted on this site, or the content and/or accuracy of such exchanges. MedHelp International does not endorse the views of any user.
Gastroenterology  (Expert Forum)
 | 
ERCP
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Post a Question Back to Forum
MedHelp Member's Question

ERCP

by Rileydmk, Jan 04, 2006 12:00AM
I am a 32 year old female with a recurrent problem! I had my gallbladder removed in September.  10 days later, I was admitted into the hospital with severe pain that turned out to be acute pancreatitis from retained stones in the common bile duct.  While hospitalized, I had an ERCP to remove the stones, and was told "the stones are gone."  After going home, I continued to experience chronic pain in the upper right quadrant that was sometimes a mild ache, sometimes a sharp stabbing pain.  I returned to the doctor for treatment in November, had another ERCP in mid-December, followed by another attack of acute pancreatitis that I was hospitalized again for 3 days.  This time the doctor removed 5 stones from the cystic duct (he called them "hidden stones").  When I was released, the doctor said that any new stones that I form, or any that are still "hidden" should fall right out because I had a complete spincterotomy.  In the three weeks since I had the last ERCP, I have continued to have pain, severe belching throughout the day, and the inability to eat much (I have lost 10 pounds).  On New Year's eve I went to the ER with what I thought was a pancreatitis attack (it disapated after 15 minutes), and all the tests performed there were normal, including CT Scan, lipase and amylase, x-rays and urine tests.

I have either diarrhea or no bowel movements at all.  I'm desperate for an answer, and the doctors seem clueless, or unavailable.  I'm tempted to try natural remedies. Is there anyone out there that has been through a similar ordeal? I'm an alarmist and have concerns about having chronic pancreatitis, so am reluctant to have another ERCP unless absolutely necessary.
Doctor's Answer

by Kevin Pho, MD, Jan 05, 2006 12:00AM
One consideration would be Sphincter of Oddi dysfunction.  This can occur more frequently in those without gallbladders.  An ERCP with Sphincter of Oddi manometry can be considered to evaluate for this condition.  If there is evidence of dysfunction, a sphincterotomy would be a reasonable treatment approach.



If there is concern about more retained bile duct stones, you can consider an MRCP - which is a less invasive test than an ERCP.  However if stones are found, you still have to undergo an ERCP to remove them.



You can discuss these options with your personal physician.



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Kevin, M.D.

kevinmd_b
Member Comments (33)

by cwwgirl, Jan 05, 2006 12:00AM
My daughter is almost 11 yrs. old. In 2004, she had her gallbladder removed (3 stones). June of 2005, she had a bile duct stone removed through ERCP. Her amylase/lipase levels were not 'text book' pancreatitus, but certainly presented itself to be pancreatitus (1 nt. turned into 4 nts. in the hospital). Her pains never went away during her hospital stay, nor when we arrived home. Over the next 3 weeks, her pain increased. By the end of July 2005, her Dr. determined he'd been wrong and she did have another 'hidden' bile duct stone (he did make the scphenter muscle wider by an incision, is this the 'schpincter oddi'). Severe pancreatitus followed that procedure (a 1 nt. stay turned into 7 nts. in the hospital).



She has been free of pain since this time, but on 12/20/05.... the pain returned. SAME EXACT pains as with the pancreatitus/stones. We were convinced that the tests would show that... however, we were wrong. After 7 nts. in the hospital, and every possible tests being done (MRCP, CT, Ultrasounds, bloodwork, stool samples) everything has come back normal. The GI Dr's have told us there is nothing more they can do for her. After having IV's/narcotics for 7 days, she was 'pain free'. Until 2 days home, when slight pains came back. Tonight, the pain is increasing again.... we are soooo frustrated and at a loss as to how to help her??!!??!

Could this be the 'sphincter oddi dsyfunction' you speak of????



PLEASE HELP?!?

BTW, the pain is upper rt. quadrant (under her ribs) and sometimes in her lower left back kidney area.

by ozark, Jan 06, 2006 12:00AM
has she been teted for a kidney infection?

by MaryRoe, Jan 06, 2006 12:00AM
I have had the Sphincture of Oddi dysfunction since having my gallbladder out in 1975.  No picnic.  



Also, did anyone tell you that ERCP's can cause pancreatitis. Many doctors quit doing ERCP's because of triggering a pancreatitis attack.  There are specialists who are well trained in doing this.



There are things than can trigger a Sphincture of Oddi attack.  Medications are one...The worst offenders for me are Morphine, Opiods and Opiod derviatives.  No, I am not a pain med freak but pills like, Vicodin (popular with DDS procedures) Tylenol with codeine, Fentynal, and the list goes on and on.  I also found that Lomotil  can trigger an attack for me.  I was warned to stay away from all narcotics as they will trigger a severe attack (Sphincture of Oddi) with me.  These attacks can last up to 10 hours with me. I am on the floor in a fetal position in severe pain.



These attacks are worse than a gall bladder attack.   What may seem to be perfectly innocent...may bring on an attack. My bathroom habits have never been the same since gallbladder removal.  My CT scans always show a bile duct enlargement.  MRCP test does not show stones.  I will not resort to another ERCP unless I know ahead of time that there was a stone lodged somewhere in there.  Personally, and I mean personally, I feel a surgeon's experience has a lot to do with the success of any surgical procedure.  I happened to of had a poor surgeon. Found this out after the fact.  His license finally was revoked some years later.



Years ago, I was told to go to a place in Wisconsin for a Sphincterectomy (sp).  They had an expert there in Racine. I had 2 small babies and never went.  There is another place that specializes also in this (if this is what you have) and I think it is in Ohio or Indiana or some place in that neck of the woods.   I know this is where I would go if I ever choose to have something done about this.  



Good Luck To You.  



by paty91356, Jan 07, 2006 12:00AM
It was very interesting to read that you are sensitive to narcotics and other pain relieving drugs...I have never spoken to anyone else with Sphincter of Oddi disfunction that has this reaction to narcotics, besides myself.

A word of caution...if you ever have to have surgery, be sure to tell your surgeon of this reaction.  

I had a total hip