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Gallbladder stones entering the liver: Is an ERCP the safest option?
I am posting on behalf of my mother.
She is 75 years old. For many years, maybe decades, she has had gallbladder stones. However, now, there are quite a few stones that are entering her liver. This is causing her serious pain.
She has two options:
1) Removal of the stones near the liver, via endoscopic retrograde cholangiopancreatography (ERCP). This would be followed by laparoscopic removal of the gallbladder itself.
2) Non-laparoscopic removal of everything, the gallbladder and the stones near the liver.
My mother hates both options. She is concerned that the ERCP would expose her to too much radiation. And the non-laparoscopic removal of everything, would leave her with a tube sticking out of her body for a few weeks. I should mention that, two years ago, she fell and broke a femoral neck (in the hip area). She had surgery to repair that.
So, which option is safer for her? Just how much radiation will she experience during an ERCP?
Thank you for any assistance.
She is 75 years old. For many years, maybe decades, she has had gallbladder stones. However, now, there are quite a few stones that are entering her liver. This is causing her serious pain.
She has two options:
1) Removal of the stones near the liver, via endoscopic retrograde cholangiopancreatography (ERCP). This would be followed by laparoscopic removal of the gallbladder itself.
2) Non-laparoscopic removal of everything, the gallbladder and the stones near the liver.
My mother hates both options. She is concerned that the ERCP would expose her to too much radiation. And the non-laparoscopic removal of everything, would leave her with a tube sticking out of her body for a few weeks. I should mention that, two years ago, she fell and broke a femoral neck (in the hip area). She had surgery to repair that.
So, which option is safer for her? Just how much radiation will she experience during an ERCP?
Thank you for any assistance.
Here is an update on my mother's situation.
After consulting with the two general surgeons mentioned in my earlier posts, as well as a gastrointestinal (GI) surgeon, my mother made an appointment to have an ERCP with the GI surgeon. However, before that ERCP took place, she decided to get the opinion of a third general surgeon.
The third general surgeon said, that my mother has stones in the Common Bile Duct (CBD), the Common Hepatic Duct (CHD), and the Intrahepatic Ducts (IHDs) (bile ducts within the liver). Removing the stones in the CBD and the CHD with an ERCP, would be an easy case. However, removing the stones in the IHDs with an ERCP, would be a hard case. The GI surgeon with whom my mother had scheduled an ERCP, was experienced in easy cases. But he had little experience in hard cases. The third general surgeon referred my mother to a second GI surgeon, someone who had a lot of experience in the hard cases.
The second GI surgeon ordered a new MRI/MRCP. After the second GI surgeon and a hepatologist examined the new MRI/MRCP, they came to the conclusion that, while the stones in the CBD and the CHD had come from the gallbladder, the stones in the IHDs were DIFFERENT from gallstones and had NOT come from the gallbladder. Furthermore, the MRI/MRCP showed that the IHDs were in bad shape. They were uneven and irregular. The second GI surgeon and the hepatologist believe, that the stones inside the IHDs are there BECAUSE the IHDs are in bad shape. Even if the stones in the IHDs can be removed with an ERCP, if the IHDs remain in bad shape, more stones will appear in the IHDs. And these two doctors can not even guarantee that an ERCP will remove all of the IHD stones.
Furthermore, an ERCP has a significant chance of giving my mother an infection. The human mouth is full of bacteria. When the ERCP tube goes through my mother's mouth, the bacteria in the mouth will attach themselves to the tube. When the tube enters the ducts, the bacteria will also enter the ducts. These bacteria can cause an infection inside the ducts.
So, right now, the ERCP appointment with the first GI surgeon has been cancelled, and the second GI surgeon and the hepatologist have ordered a liver biopsy in order to obtain more information.
After consulting with the two general surgeons mentioned in my earlier posts, as well as a gastrointestinal (GI) surgeon, my mother made an appointment to have an ERCP with the GI surgeon. However, before that ERCP took place, she decided to get the opinion of a third general surgeon.
The third general surgeon said, that my mother has stones in the Common Bile Duct (CBD), the Common Hepatic Duct (CHD), and the Intrahepatic Ducts (IHDs) (bile ducts within the liver). Removing the stones in the CBD and the CHD with an ERCP, would be an easy case. However, removing the stones in the IHDs with an ERCP, would be a hard case. The GI surgeon with whom my mother had scheduled an ERCP, was experienced in easy cases. But he had little experience in hard cases. The third general surgeon referred my mother to a second GI surgeon, someone who had a lot of experience in the hard cases.
The second GI surgeon ordered a new MRI/MRCP. After the second GI surgeon and a hepatologist examined the new MRI/MRCP, they came to the conclusion that, while the stones in the CBD and the CHD had come from the gallbladder, the stones in the IHDs were DIFFERENT from gallstones and had NOT come from the gallbladder. Furthermore, the MRI/MRCP showed that the IHDs were in bad shape. They were uneven and irregular. The second GI surgeon and the hepatologist believe, that the stones inside the IHDs are there BECAUSE the IHDs are in bad shape. Even if the stones in the IHDs can be removed with an ERCP, if the IHDs remain in bad shape, more stones will appear in the IHDs. And these two doctors can not even guarantee that an ERCP will remove all of the IHD stones.
Furthermore, an ERCP has a significant chance of giving my mother an infection. The human mouth is full of bacteria. When the ERCP tube goes through my mother's mouth, the bacteria in the mouth will attach themselves to the tube. When the tube enters the ducts, the bacteria will also enter the ducts. These bacteria can cause an infection inside the ducts.
So, right now, the ERCP appointment with the first GI surgeon has been cancelled, and the second GI surgeon and the hepatologist have ordered a liver biopsy in order to obtain more information.
1 Comments
Sorry to hear that her condition just keeps getting more complicated, a solution and return to being healthy sure will be nice.
Yes, putting off the ERCP until her underlying hepatobiliary condition is better known makes sense. You already noted some of the ERCP risks and another is that the procedure requires adding more than normal pressure to her apparently diseased bile ducts. This can cause ruptures/leaks that will make her condition even worse.
Liver biopsies are risky but it is definitely warranted in her case. She may have an underlying chronic disease like PBC or PSC which the biopsy will likely be able to diagnose. And knowing her liver's exact fibrosis and grade will be very helpful. I've had quite a few biopsies myself and it hasn't been difficult in my case. If they can use a core needle instead of FNA, the pathologist will be able assess and diagnose more effectively. But doctors will be wanting to mitigate the risks, so it's a trade-off of course.
Take care and hope things workout well.
Yes, putting off the ERCP until her underlying hepatobiliary condition is better known makes sense. You already noted some of the ERCP risks and another is that the procedure requires adding more than normal pressure to her apparently diseased bile ducts. This can cause ruptures/leaks that will make her condition even worse.
Liver biopsies are risky but it is definitely warranted in her case. She may have an underlying chronic disease like PBC or PSC which the biopsy will likely be able to diagnose. And knowing her liver's exact fibrosis and grade will be very helpful. I've had quite a few biopsies myself and it hasn't been difficult in my case. If they can use a core needle instead of FNA, the pathologist will be able assess and diagnose more effectively. But doctors will be wanting to mitigate the risks, so it's a trade-off of course.
Take care and hope things workout well.
The surgeon is right wrt the herbal supplement. We are talking large, concentrated stones, surgery is the only option for removal, if that is required is there an underlying disease as well? It sounds like the surgery is the only option, and of the stones are big, you have to do it. If a stone were to block the CBD (common bile duct), then the bile will backup into her liver. This is very bad, your bile helps you to digest your food. So you can imagine what the pooling bile inside of her liver will do, if it cannot get out. The bile will quickly destroy her liver. They should be doing frequent liver panel blood tests to monitor this. If the bile does backup, her liver enzymes will rise quickly, especially the ALT, Bilirubin and ALP. Hope you find a good solution and let us know how things are going. Take care.
Well, here is an update on my mother's situation.
She spoke to one surgeon, and this surgeon advised her to do the ERCP and the laparoscopic removal of the gallbladder.
Today, she spoke to a second surgeon. This surgeon is the business partner of the first surgeon, and is also the Chairman of the hospital's Surgery Department. This surgeon said that there will be risks of complications no matter what option my mother chooses. He said that the ERCP is reasonable, and that the complications associated with an ERCP are very uncommon. However, if she wants to do a non-laparoscopic removal of the gallbladder and the stones near the liver (open surgery, as the surgeon calls it), that can be done as well.
My mother asked the second surgeon whether the herb Nigella Sativa will remove the stones. The second surgeon said that he does not believe that the herb will accomplish anything. He also said that, if all stones are removed without the gallbladder being removed, then more stones will be formed in the gallbladder in the future. So, it appears that, even if the herb does remove the stones (without removing the gallbladder), more stones will be formed in the future.
She spoke to one surgeon, and this surgeon advised her to do the ERCP and the laparoscopic removal of the gallbladder.
Today, she spoke to a second surgeon. This surgeon is the business partner of the first surgeon, and is also the Chairman of the hospital's Surgery Department. This surgeon said that there will be risks of complications no matter what option my mother chooses. He said that the ERCP is reasonable, and that the complications associated with an ERCP are very uncommon. However, if she wants to do a non-laparoscopic removal of the gallbladder and the stones near the liver (open surgery, as the surgeon calls it), that can be done as well.
My mother asked the second surgeon whether the herb Nigella Sativa will remove the stones. The second surgeon said that he does not believe that the herb will accomplish anything. He also said that, if all stones are removed without the gallbladder being removed, then more stones will be formed in the gallbladder in the future. So, it appears that, even if the herb does remove the stones (without removing the gallbladder), more stones will be formed in the future.
The ERCP route is very useful, but very dangerous ... especially for her. I would take my time and get several additional consults. Push them for quick answers, but get the extra options first. An ERCP for a young. healthy person is difficult. But you need to do something of course. Even try MAYO, they will do consults via the internet ... no need to fly out. Good luck.
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