Biliary Tree problems and ERCP

[mixedup]

I have had 4 ERCP's...the first was because of intense right upper quadrant pain, vomiting, nausea, diarrhea, etc. and the doctors could find nothing else wrong so they did an ERCP with manometry. The manometry showed a number of 50. They cut the sphincter of the pancreas. I still was having problems, so they did another ERCP with manometry and this time the number was 200...so they cut again and they gave me pancreatitis.  I spent 9 days in the hosptital. A couple of years later, I was told I needed another ERCP..this time they put in a shunt..which they removed a couple of days later.  About a year later, another ERCP.  I am still in pain, still have chronic nausea, chronic vomiting (it is not too bad as long as I don't eat normal food)and chronic diarrhea. I was diagnosed with gastroparesis, had polio as a child and now apparently have Post-Polio syndrome and I have degenerative disc disease in my low back and neck. I was just sent to a gastroenterologist by my new primary doctor to see what "new" stuff is available. He ordered an MRCP which showed no biliary tree problems..but the blood tests show ALK Phos at 179 (normal is 40-120) and ALT at 65 (normal is 9-52). This guy wants another ERCP...BUT I DON'T!! He already told me that I have to stay on a "liquid" diet because of the gastroparesis...so why bother when the ERCP will cause me SEVERE pain and SEVERE nausea, etc.  I would like another opinion...are the liver tests that out of whack considering my other problems?  

[Kevin Pho, MD]

There has been a comprehensive evaluation with multiple ERCPs.  I cannot give specific recommendations without examining you and your chart.  

The MRCP will make problems in the biliary tree less likely, however that test isn't as comprehensive as the ERCP.  Obtaining another GI opinion can be considered to see whether repeating the ERCP is necessary.

If the pancreas is in question, you can consider an MRI or endoscopic ultrasound to further evaluate the organ.  If the liver is in question (i.e. persistently elevated enzymes), a liver biopsy can be discussed.  

Gastroparesis can be treated with medical therapy like erythromycin and Reglan.  

These options can be discussed 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_

[rose9]

A related discussion, intrahepatic billary tree was started.