Biopsy and ERCP results questions

[Guest guest]

I had a liver biopsy August 10th. I didn't want to have the biopsy

but my dr. kept pushing so I finally gave in. I was to have a follow-

up appt with my dr. on August 22nd to go over the results. The Dr's

office called on the day of my appt and cancelled. The nurse told me

that my dr. decided to send the biopsy out to get a second opinion.

She wouldn't tell me what the first set of results were or give me

any additional info other than the slides were sent to a liver

specialist at the Cleveland Clinic. My new follow-up appt to discuss

the results is not until Oct 12th. That's seven long weeks away.

I started to worry about why the dr. felt concerned enough to get

another opinion, especially since early on the dr's said the

stricture in my common bile duct might have been caused by cancer. A

co-worker suggested that I go to the hospital and ask for my medical

records. So I did and they gave me copies of my biopsy results and

all 3 of the ERCP's that I've had this year.

I read the liver biopsy results and they seemed pretty good to me.

Of course, I don't know what the heck I'm reading so I was wondering

if someone could help me out. It says " mild nonspecific fibrous

expansion of the portal tracts with minimal lobular inflammation " It

also says that " the histologic features are nonspecific and not

diagnostic " . I'm not sure why the dr. felt compelled to get another

opinion although his nurse assured me that my insurance would pay for

the out-of-network referral so I guess that's ok. If anyone could

let me know if this seems good, bad or unexpected I would appreciate

it.

Also my most recent ERCP report says that my common bile duct had

stricturing, dilatation and bleeding. The doctor never mentioned

bleeding to me and it wasn't listed on the other 2 ERCP reports. Is

this common? I'm starting to wonder now if all the ERCP's and the

stents are helping or hurting. I don't like the idea that its

bleeding and there's a piece of plastic in it. I have had a stent

since last Oct. The dr. wants me to have it changed again in Sept.

and then removed in December.

Any help or advice would be greatly appreciated. This whole thing is

starting to feel a little overwhelming.

Thanks,

Darcy

[Guest guest]

Hi Darcy,

I don't have personal experience but when my endoscopist/gastro

discussed putting in a plastic stent he was talking about 4-8 weeks,

not a year. If you are having bleeding it does seem like they should

take it out.

The second opinion on the biopsy may be more related to wanting a

second pathologist to make a diagnosis because the first couldn't say

if it was PSC for sure. The biopsy is unlikely to clarify the cancer

question. Biopsies sample the liver tissue itself. The common bile

duct is outside the liver. The CBD is the most common location for

bile duct cancer, but it's also the most common site of major

strictures, so don't panic. Imaging studies may help clarify what's

going on with the stricture, in addition to the biopsies and brushings

during the ERCP.

Good for you on getting your records. I keep a parallel set with all

my lab tests and imaging studies because I am seen locally and at a

hospital in Boston too.

Any time you want to speak to the doctor, you should feel free to call

and leave a message for him to call you back. If he cancels an

appointment on you and the assistant won't tell you anything, you

should feel fully justified in calling him. He wouldn't be happy if

one of his family members was left in this kind of limbo- he can spend

the 5 min to call you back and explain. You deserve that kind of respect!

Best wishes,

Martha (MA)

UC, 1979, PSC 1992, asymptomatic

>

> I had a liver biopsy August 10th. I didn't want to have the biopsy

> but my dr. kept pushing so I finally gave in. I was to have a follow-

> up appt with my dr. on August 22nd to go over the results. The Dr's

> office called on the day of my appt and cancelled. The nurse told me

> that my dr. decided to send the biopsy out to get a second opinion.

> She wouldn't tell me what the first set of results were or give me

> any additional info other than the slides were sent to a liver

> specialist at the Cleveland Clinic. My new follow-up appt to discuss

> the results is not until Oct 12th. That's seven long weeks away.

>

> I started to worry about why the dr. felt concerned enough to get

> another opinion, especially since early on the dr's said the

> stricture in my common bile duct might have been caused by cancer. A

> co-worker suggested that I go to the hospital and ask for my medical

> records. So I did and they gave me copies of my biopsy results and

> all 3 of the ERCP's that I've had this year.

>

> I read the liver biopsy results and they seemed pretty good to me.

> Of course, I don't know what the heck I'm reading so I was wondering

> if someone could help me out. It says " mild nonspecific fibrous

> expansion of the portal tracts with minimal lobular inflammation " It

> also says that " the histologic features are nonspecific and not

> diagnostic " . I'm not sure why the dr. felt compelled to get another

> opinion although his nurse assured me that my insurance would pay for

> the out-of-network referral so I guess that's ok. If anyone could

> let me know if this seems good, bad or unexpected I would appreciate

> it.

>

> Also my most recent ERCP report says that my common bile duct had

> stricturing, dilatation and bleeding. The doctor never mentioned

> bleeding to me and it wasn't listed on the other 2 ERCP reports. Is

> this common? I'm starting to wonder now if all the ERCP's and the

> stents are helping or hurting. I don't like the idea that its

> bleeding and there's a piece of plastic in it. I have had a stent

> since last Oct. The dr. wants me to have it changed again in Sept.

> and then removed in December.

>

> Any help or advice would be greatly appreciated. This whole thing is

> starting to feel a little overwhelming.

>

> Thanks,

> Darcy

>

[Guest guest]

Hi Darcy;

I would agree with Martha ... I wouldn't be too worried about what

was said in the biopsy results, and wouldn't be too concerned by the

fact that your doctor has sent the biopsy samples to a liver

specialist at Cleveland Clinic. Interpreting biopsies can be a bit

tricky from what I understand. When our son was being evaluated for

PSC they did a biopsy first with inconclusive results, and followed

that with an ERCP, which showed PSC. We then went for a second

opinion at Mayo Clinic and had the biopsy slides sent there. Mayo

Clinic were able to recognize PSC in the biopsy samples, and were

able to stage it at stage 2. The bottom line is that some centers

seem to have better expertise than others in interpreting biopsy

specimens (I would suspect that this is proportional to the number of

liver samples that they have seen). As Martha mentioned, biopsy would

not be the approach of choice to look for cancer; rather they would

tend to take cell brushings of the bile ducts when doing an ERCP, and

then look at the cells recovered from the brushings for evidence of

abnormalities.

I am not sure what to make of the bleeding seen in the last ERCP? I

would ask if the endoscopist thought that this was caused by the

stent, or occurred as a result of the ERCP itself, or is due to other

causes. There have been reports of " hemobilia " (blood in the bile)

associated with the use of stents, or following a liver biopsy:

Frost A, MA, Parks RW. An unusual cause of haemobilia--beware

the forgotten stent! Int J Clin Pract. 2007 May;61(5):877-8. PMID:

17493095.

Dallal RM, G, Lord JL, Zaki R, L, Manzarbeitia C.

Hemobilia: a rare complication after routine liver biopsy during

gastric bypass. Surg Obes Relat Dis. 2007 Jan-Feb;3(1):91-3. PMID:

17241941.

Did the last ERCP (with report of " bleeding " ) occur following the

liver biopsy? If not, then it may be related to the plastic stent

that has been in place since last October [if I recall correctly]?

Best regards,

Dave

(father of (22); PSC 07/03; UC 08/03)

[Guest guest]

Thank you so much Martha, and Nina for your replies. I was

starting to worry and you definitely helped alleviate my concern. I

tried to talk to my dr. today but of course he was on vacation.

The bleeding was on my ERCP report from June. I had the biopsy in

August. I have had a stent in place since October of 2006. They have

changed it 4 times. I have had 5 ERCP's since October with number 6

scheduled for Sept. They want to change the stent again in Sept and

then remove it in December and see what happens. For some reason my

doctor is obsessed with me having a stent for a minimum of a year. I

don't really get to talk to the endoscopist. I only see him in the

ERCP room for about 30 seconds before I disappear off into la-la land.

My Dr then talks to the endoscopist and relays the info to me at my

appts. They work in the same office.

I really appreciate the article, . I keep telling my dr. that I'm

uncomfortable with having the stent so long and now that I can show him

the article and mention the bleeding from the report maybe he'll

reconsider.

>

Thanks again,

Darcy

> Did the last ERCP (with report of " bleeding " ) occur following the

> liver biopsy? If not, then it may be related to the plastic stent

> that has been in place since last October [if I recall correctly]?

>

[Guest guest]

For contrast, my stent was in for two weeks (spring 2001 at Mayo, Rochester).

I've been asymptomatic since, though.

Arne

---- dmelzer514 wrote:

.... For some reason my doctor is obsessed with me having a stent for a minimum

of a year...

[Guest guest]

Darcy,

I have had a stent for four months without

changing it. My hepatologist planned to change stents for a year like you

describe, but he left the decision to the endoscopist to replace or only to

remove the stent during the procedure. He even considered putting in two (I

never understood if they were supposed to be at the same place, or one after

the other). The endoscopist decided there was no need to put another stent in

after four months and I have been asymptomatic since (close to two years).

Chaim Boermeester, Israel.

From:

[mailto: ] On Behalf Of stonehollow@...

Sent: Friday, August 31, 2007

03:34

To:

Cc: dmelzer514

Subject: Re: Re:

Biopsy and ERCP results questions

For

contrast, my stent was in for two weeks (spring 2001 at Mayo, Rochester). I've been asymptomatic since,

though.

Arne

---- dmelzer514 <dmelzer514 (AT) yahoo (DOT) com>

wrote:

.... For some reason my doctor is obsessed with me having a stent for a minimum

of a year...

[Guest guest]

Chaim, Glad to hear you have been asymptomatic since your stent removal and that the stent thing worked for you. I hope I have a smiliar experience. Thanks, Darcy have been asymptomatic since (close to two years).

Moody friends. Drama queens. Your life? Nope! - their life, your story. Play Sims Stories at Yahoo! Games.

[Guest guest]

Darcy,

Me too!

Chaim

From:

[mailto: ] On Behalf Of Darcy Melzer

Sent: Friday, August 31, 2007

18:21

To:

Subject: RE: Re:

Biopsy and ERCP results questions

Chaim,

Glad to hear you have been asymptomatic since your stent removal and

that the stent thing worked for you. I hope I have a smiliar

experience.

Thanks,

Darcy

have been asymptomatic since (close

to two years).

 

Moody friends. Drama queens. Your life? Nope! - their life, your story.

Play Sims

Stories at Yahoo! Games.