is ERCP really needed based on tests?

[phillida]

I am 54 year old female experiencing pain/soreness in upper right side under ribs for months.  Other symptoms include dysphasia, bloated, constipated, gas, and tired. I have tried numerous things over the past seven months to alleviate these conditions including change of diet and colon cleansing products.  I recently had the following tests -bloodwork,  Ultrasound of abdomen, EGD, MRI/MRCP.  I have copies of all reports which indicate the following:  LDL 161, Chol 234, Trig, 142, HDL 45,  TSH 2.96;  Ultrasound reveals dilated common bile duct measuring 9mm; EGD revealed esophagus, gastric mucosa, duodenal bulb all normal. Gastric biopsy revealed mild superficial chronic gastritis, and no evidence of atrophic or active gastritis.  MRI reveals no pancreatic mass or lymphadenopathy is seen. Mild promience of the common bile duct.  MRCP reveals same..mild prominence of common bile duct extending to the level of the ampulla. Etiology is uncertain..maybe chronic, or a stricture or tumor at the level of the ampulla cannot be excluded.
Correlation is suggested with respect to bilirubin levels and symptomology.  If further eval of ampulla is necessary, consideration should be given to evaluate biliary tree by ERCP. This is suggested however only if felt clinically indicated.  My doctor wants me to have the ERCP but I am concerned about the procedure (5% get pancreatitis) plus it is more invasive. He has only done 140 or so of these and has had five percent of his patients get pancreatitis. I am asking for any suggestions of what to do now as I asked the doctor to postpone.until I get two second opinions (by radiologist and gastronenterologist).. He still believes I should have the procedure but knows I am seeking other opinions. I have several weeks off from work and would like to get my health in order.. I would prefer doing anything natural and not having anymore tests but will if I must.
Thanks.

[Kevin Pho, MD]

An ERCP would indeed be a reasonable next step.  This is a more comprehensive evaluation than an MRCP, and may detect the cause of the biliary dilation.  If there is a stone, blockage or stricture, the ERCP may be able to treat it.

Pancreatitis is indeed a complication of the test, and I'm sure this will be discussed with your personal physician.

Obtaining another opinion prior to the test is recommended, preferably at a major academic medical center.

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 patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com

[Betty600]

A related discussion, Dilated common bile duct was started.

[Jaybay]

The doctors only reply once on these forums, so it's unlikely he's seen your followup questions.

MRCP evaluates for pressures at the sphincter of oddi, and allows the doctor to get a glimpse of what may be inside the bile duct.  If sludge or stones are identified, the procedure is converted to ERCP which is the treatment for getting rid of all that junk.  If the sphincter muscles are clenched too tightly, the doctor can perform a sphincterotomy at this time.  A sphincterotomy means those tiny little muscles located where the common bile duct empties into the duodenum, are cut away.  I have had this procedure done myself, and it's little different from having an endoscopy.  I didn't develop full-blown pancreatitis, but I was pretty sick and in a fair amount of pain for about a month.  After that, everything settled down considerably.

When you discuss this procedure with your doctor, ask him about his personal incidence of post-ERCP pancreatitis.  There are so many conflicting statistics on this on the internet - anywhere from 3% to 15% - but the most important statistic is with your own doctor.  From what you've written about your case, it sounds as if you really have no choice but to go through with the procedure.  

[phillida]

You stated on a previous answer /post "that biliary duct stones can be excluded after an MRCP"...

Why do you think this hasn't been done or stated in reports based on info above?

It is unclear why the biliary duct is 9mm but no one has ruled out a stone based on my MRCP..

Curious what your thoughts are?

[phillida]

You stated on a previous answer /post "that biliary duct stones can be excluded after an MRCP"...

Why do you think this hasn't been done or stated in reports based on info above?

It is unclear why the biliary duct is 9mm but no one has ruled out a stone based on my MRCP..

Curious what your thoughts are?

[phillida]

You stated on a previous answer /post "that biliary duct stones can be excluded after an MRCP"...

Why do you think this hasn't been done or stated in reports based on info above?

It is unclear why the biliary duct is 9mm but no one has ruled out a stone based on my MRCP..

Curious what your thoughts are?

[phillida]

I was under the impression that MRCP was less invasive and ability for detail is much better, that is why I had the MRI/MRCP done.  Do you suggest having another radiologist read the scans ?
I am having a difficult time finding a doctor (radiologist or other) for consult/second opinion? All the data is availalbe online and I have copies of all reports. Any suggestions?

Thank you.