Anther ERCP question

[Guest guest]

Ok. I have been talking with my Drs office today about the ERCP &

there are some things that are starting to bother me.

When I talked with the doctor on Tuesday, I did not absorb everything

that he said. I was trying to digest some unexpected good news (y AST

& ALT have dropped back to the normal range & my ALP has dropped from

the 800s to 212.) I have been on Actigall for 6 months, so I think

that is what brought my LFTs back down. The MRCP showed a bulge in my

CBD that could be congenital, a cyst, or a result of a past blockage.

No current blockage or stones were seen in the MRCP. My doctor

described what he would do during the ERCP, and it didn't all sink in

at the time. But my understanding was that the primary benefit of

this ERCP is to look at my bile ducts to see if any signs of PSC can

be seen, and to look at this bulge to see if they can find a cyst that

couldn't be seen on the MRCP. He mentioned to me that he wanted to

" brush out the ducts " , but I didn't realize what that entailed at the

time. I do remember him saying that the risks and the benefits of the

ERCP for me are about even right now. I took that to mean that if I

did have some obstruction or stricture that needed to be opened, the

benefits would outweigh the risks. But since I don't, it's about even.

When I talked with the nurse today, she mentioned that he would be

putting a stent in. I didn't understand that until she explained that

he would need to put it in open the ducts while he brushed them out.

She also said that he wants to sweep out the stones. (What stones?)

Then, the stent will be left in & either pass on its own, or it will

be taken out by another ERCP in about a month. I asked her: why is it

necessary to increase my risk for complications by putting in a stent

to brush out stones that, according to the MRCP, are not there? And

then leave me open to having to go through another ERCP if the stent

has to be removed.

My doctor is going to call me back to discuss this. Am I

over-reacting? I realize that the MRCP could have missed some stones

that might be there, but if there was no sign of any blockage and my

LFTs are returning to normal, why add risk by doing the stent/brushing ?

I realize that brushing out the ducts is sometimes done to check for

any cancerous cells, but I asked about this and they are not looking

for cancer & not planning to take anything from the ERCP to biopsy.

Does this sound reasonable?

Debbie in NC

[Guest guest]

Debbie,

No it doesn't sound reasonable to me. They might want to do those things based on what they find, but to be planning to do al that sounds like a make work project. Do doctors in the US have make work projects??

Ian (51) PSC 89

Ok. I have been talking with my Drs office today about the ERCP & there are some things that are starting to bother me.When I talked with the doctor on Tuesday, I did not absorb everythingthat he said. I was trying to digest some unexpected good news (y AST

& ALT have dropped back to the normal range & my ALP has dropped fromthe 800s to 212.) I have been on Actigall for 6 months, so I thinkthat is what brought my LFTs back down. The MRCP showed a bulge in my

CBD that could be congenital, a cyst, or a result of a past blockage.No current blockage or stones were seen in the MRCP. My doctordescribed what he would do during the ERCP, and it didn't all sink inat the time. But my understanding was that the primary benefit of

this ERCP is to look at my bile ducts to see if any signs of PSC canbe seen, and to look at this bulge to see if they can find a cyst thatcouldn't be seen on the MRCP. He mentioned to me that he wanted to

" brush out the ducts " , but I didn't realize what that entailed at thetime. I do remember him saying that the risks and the benefits of theERCP for me are about even right now. I took that to mean that if I

did have some obstruction or stricture that needed to be opened, thebenefits would outweigh the risks. But since I don't, it's about even.When I talked with the nurse today, she mentioned that he would be

putting a stent in. I didn't understand that until she explained thathe would need to put it in open the ducts while he brushed them out. She also said that he wants to sweep out the stones. (What stones?)

Then, the stent will be left in & either pass on its own, or it willbe taken out by another ERCP in about a month. I asked her: why is itnecessary to increase my risk for complications by putting in a stent

to brush out stones that, according to the MRCP, are not there? Andthen leave me open to having to go through another ERCP if the stenthas to be removed. My doctor is going to call me back to discuss this. Am I

over-reacting? I realize that the MRCP could have missed some stonesthat might be there, but if there was no sign of any blockage and myLFTs are returning to normal, why add risk by doing the stent/brushing ?

I realize that brushing out the ducts is sometimes done to check forany cancerous cells, but I asked about this and they are not lookingfor cancer & not planning to take anything from the ERCP to biopsy.

Does this sound reasonable?Debbie in NC -- Ian Cribb P.Eng.

[Guest guest]

-

Some doctors do have " make work " projects, most do not. The

reimbursement rates by insurance companies and HMOs are not as high as

you might think. I left the doctor who proposed another ERCP just to

take a look around after the first ERCP caused pancreatitis and the

second caused an infection that nearly took my life. It took me all

of a nanosecond to decide that he was way too aggressive for me. All

he had to do was read the paperwork I provided with the AFP numbers to

know that the number was normal for me and not indicative of

cholangiocarcinoma. My MRCP this week says no changes (improvement

was noted earlier in the disease process) and my last blood work was

normal.

Penny

-- In , " Ian Cribb " wrote:

>

> Debbie,

>

> No it doesn't sound reasonable to me. They might want to do those

things

> based on what they find, but to be planning to do al that sounds

like a make

> work project. Do doctors in the US have make work projects??

>

> Ian (51) PSC 89

>

[Guest guest]

On 9/20/07, Debbie Rasa > wrote:

Does this sound reasonable?

Not as you describe it. The advantage of ERCPs is that the endoscopist can actually do something to alleviate blockages. With dye injection, there's also absolutely no question as to whether they are stenosed (narrowed). As you correctly state, it also allows brushings of the bile duct walls to be taken for cancer screening. I'm not aware of any other reason to take brushings.

Stents are routinely placed in areas that had to be expanded via balloon dilatation. The duct walls need to " heal " in order to stay at the dilated diameter, otherwise they may collapse and scar more. They are typically removed after 6 weeks (sometimes more). I'm not aware of anyone planning on them passing by themselves, although it does happen.

The discussion on sweeping out stones is beyond my experience - doesn't make sense.

I recommend you write down your questions and make sure they are all answered. That's not what most doctors want in a patient (in my experience), but it is certainly your right. You ARE the customer!

Arne

56 - UC 1977, PSC 2000

Alive and (mostly) well in Minnesota

[Guest guest]

Thanks to Ian, Peggy, & Arne for responding to me. I just spoke with

my doctor & found that this was a misunderstanding. The nurse was

telling me all the possibilities as required by the consent form, not

everything he is planning. (I have had frequent misunderstandings &

miscommunications from the nurses in this office. I need to quit

taking anything seriously until I discuss it with the doctor)

He is planning to go in just to look at my bile ducts and this bulge.

He does think I may have obstructive biliary disease (sludgy

bile)that has been helped by Actigall & that the bulge was a result of

an obstruction. If I understand correctly, he is planning to put in a

balloon, & sweep to look for any evidence of obstructive biliary

disease that may remain. He is not planning to put in a stent unless

he finds something unexpected when he gets in there.

Thanks to all who responded to my initial post about my anxiety over

this procedure. I have talked with the doctor about my fears & they

are having me come in a couple days before the procedure to meet with

the anesthesiologist & so I will go over all concerns then, too.

I am feeling much better about this. Thanks for all your replies &

encouragement. I will post an update after it's over.

Debbie in NC

>

> Ok. I have been talking with my Drs office today about the ERCP &

> there are some things that are starting to bother me.

>

> When I talked with the doctor on Tuesday, I did not absorb everything

> that he said. I was trying to digest some unexpected good news (y AST

> & ALT have dropped back to the normal range & my ALP has dropped from

> the 800s to 212.) I have been on Actigall for 6 months, so I think

> that is what brought my LFTs back down. The MRCP showed a bulge in my

> CBD that could be congenital, a cyst, or a result of a past blockage.

> No current blockage or stones were seen in the MRCP. My doctor

> described what he would do during the ERCP, and it didn't all sink in

> at the time. But my understanding was that the primary benefit of

> this ERCP is to look at my bile ducts to see if any signs of PSC can

> be seen, and to look at this bulge to see if they can find a cyst that

> couldn't be seen on the MRCP. He mentioned to me that he wanted to

> " brush out the ducts " , but I didn't realize what that entailed at the

> time. I do remember him saying that the risks and the benefits of the

> ERCP for me are about even right now. I took that to mean that if I

> did have some obstruction or stricture that needed to be opened, the

> benefits would outweigh the risks. But since I don't, it's about even.

>

> When I talked with the nurse today, she mentioned that he would be

> putting a stent in. I didn't understand that until she explained that

> he would need to put it in open the ducts while he brushed them out.

> She also said that he wants to sweep out the stones. (What stones?)

> Then, the stent will be left in & either pass on its own, or it will

> be taken out by another ERCP in about a month. I asked her: why is it

> necessary to increase my risk for complications by putting in a stent

> to brush out stones that, according to the MRCP, are not there? And

> then leave me open to having to go through another ERCP if the stent

> has to be removed.

>

> My doctor is going to call me back to discuss this. Am I

> over-reacting? I realize that the MRCP could have missed some stones

> that might be there, but if there was no sign of any blockage and my

> LFTs are returning to normal, why add risk by doing the stent/brushing ?

>

> I realize that brushing out the ducts is sometimes done to check for

> any cancerous cells, but I asked about this and they are not looking

> for cancer & not planning to take anything from the ERCP to biopsy.

>

> Does this sound reasonable?

>

> Debbie in NC

>