ERCP w/ mamonetry

[Guest guest]

Well we saw the doc yesterday, and they want him to get this done in

the next few weeks. They said that they strongly suspect that this

is the problem, and they will cut the muscle open while they are in

there.

We are pretty nervous. the doc says there is less then 5% risk of

pancreatitis w/ this procedure, but from what I've read...it's much

higher.

Anybody who has gone through this...we would appreciate any

advice/info you can give us.

thanks you.

&

dk_40207 @ yahoo.com

[Guest guest]

& ,

I have had only one occasion where I HAVEN'T had a pancreatitis

flare up after an ERCP, and that is because the pancreatic duct

didn't get touched in any way. I always take a hospital bag with me

if I am having an ERCP and my doctor advises me everytime to prepare

to be admitted, as I usually wake up to an attack, or one starts not

to long after, usually when i'm on my way home.

[Guest guest]

Hi,

There are a few things that you can ask your doctor to reduce

your anxiety about the possibility of pancreatitis from the

procedure. First of all, you need to make it clear exactly what he

is going to do. If he is concentrating mainly on the biliary duct

part of the sphincter of Oddi then he may not even go near the

pancreas. In this case, the procedure is actually only a ERC - the

C standing for the cholangiogram. Lots of times, doctors only do

the ERC but refer to it as an ERCP when talking to their patients.

This is an important thing to get cleared up before the procedure!

If, the ERC is only done then the chance of your husband getting

pancreatitis from it is lower than if the whole ERCP is done. The

reason too, why this is important to know ahead of time is that

you will find out what your endoscopist's protocal is for this

disorder - and what to do if things do not get better after the

biliary sphincterotomy.

For example. Some endoscopists follow the protocol that if the

pressures are high in manometry to only cut the sphincter that

controls the flow of bile. They do this because it is less risky to

the patient and can fix the problem a lot of the time. Then they tell

the patient to wait 8 weeks or so and if they are still feeling badly,

that they will do another ERCP - but this time looking at the

pancreas ducts and if the pressure is high on the pancreas side

of the sphincter, then they will cut that one at that time.

The other protocol that some endoscopist follow is to do

manometry on both the biliary aspect of the sphincter and the

pancreas part and cut both if the pressures indicate

abnormalities. These doctors believe that there is a better

chance of getting right to the heart of the matter and that there

are ways to reduce the risk.

Oh! then there is the whole protocols of using stents. Some

doctors use stents after a sphincterotomy to prevent any swelling

from the cut to close off the duct....and other doctors don't. So you

need to know what your doctor chooses to do in certain

situations. And you need to know if he does use stents, what

kind? The type that leave on their own (confirmed by simple x-rayt

that they are gone) or the type that needs to be removed by

endoscopy.

In your husbands specific case - with a history of pancreatitis -

leads me to believe that your doctor will go the whole nine yards.

He is obligated to take a look at the pancreas to look for reasons

for the attacks like SOD, pancreas divisum, obstruction,

calcification, etc. Because your husband history, he is at a

higher risk than someone without this history but at the same

time, he is at a lower risk than others that undergo this

procedure for SOD (young woman without a history of

pancreatitis but suspected of SOD are the highest risk group I

think).

The procedure itself is relatively easy. I have had 3 ERCPs and 1

ERC and only had pancreatitis on two of them and both times it

was relatively mild. The time when I had the manometry for SOD

and the biliary part of the sphincter cut I did not have any

complications. So, it is hard to predict. But the reason I

emphasize finding out ahead of time what your endoscopist is

intending to do is that I had this scenario happen to me. I went in

for the first ERCP with the understanding that a tentative problem

found by MRCP would be investigated by the ERCP. It wasn't.

The endoscopist focused solely on the SOD possibility, ignored

my pancreas problem and created the situation where I had to

go in a second time for the real ERCP three weeks later (I chose

to go to another hospital at that point, as you can understand). It

was at this procedure that my ongoing pancreas problem was

found. So I am on a mission to warn people to get all the

information ahead of time ! Don't let your doctors get tunnel

visioned. If you are going through the hassle of the ERCP make

sure you know exactly what the doctor is going to do: the ERC

with sphincterotomy / stents if needed.....or the whole ERCP with

sphincterotomy / stenting if needed. But the good news is, the

biliary sphincterotomy has corrected my colic attacks due to the

SOD. The bad news is, that it didn't do anything to correct my

early stage chronic pancreatitis. Mainly because I delayed three

years in getting a diagnosis.........So, the earlier you get to the

bottom of this, the better chance that it can be corrected.

In my experience, the ERCP should be able to diagnose and

hopefuly correct, the problem that your husband is having. I

would be optimistic that you are on the right track.

Laurie