23.09.2013

Treat bile duct cancer 2014

Eastern cultures have used ox bile to treat constipation and prevent gallstones and cirrhosis of the liver for centuries.
Disney engineers designed special paints to help camouflage unsightly park features like utility boxes and back doors.
Ox bile has a number of medicinal uses, but is perhaps most popular as a way for patients to improve their metabolic processing of fats and certain vitamins, and as a treatment for chronic constipation.
Bile is a substance excreted by the livers of mammals to assist in the chemical breakdown of fats and the absorption of certain vitamins in the digestive process.
The liver stores bile in a small sac called the gallbladder, from which it is distributed to the body. Some of the most common side effects of ox bile extract are nausea, upset stomach and diarrhea, often as a result of exceeding the recommended dosage. Endoscopic retrograde cholangiopancreatography, or ERCP, is an endoscopic technique that is used to examine and treat problems in the bile and pancreatic ducts, and the gallbladder. ERCP is performed by gastroenterologists or surgeons who are specially trained in this technique. You should discuss all current medications with your doctor, as some may need to be adjusted or temporarily stopped prior to the procedure. It is important to tell your doctor if you have obstructive sleep apnea or other lung conditions? If you wear CPAP at night, you should discuss with your doctor whether you should bring your machine with you on the day of your procedure.
If you have any heart conditions, you should also discuss these with your doctor, as special testing prior to your procedure may be needed. You will need a family member or friend to accompany you on the day of your procedure in order to transport you home after you have received sedative medications.
Upon arriving at the endoscopy unit, you will answer questions about your medical history and your medications will be reviewed.
You will be brought to the ERCP room and will be positioned on a special table that allows for x-rays to be taken. Depending on what is seen during the ERCP, a variety of techniques may be performed, including taking biopsies, widening the sphincter (sphincterotomy), removing stones, placing a stent (tube) across any narrowed areas, or other treatments. Once the procedure is finished, you will be brought to the recovery room and monitored while the sedative medications wear off. While ERCP is generally a safe and well-tolerated procedure, several risks are associated with it.
Infection of the bile ducts (cholangitis) can occur, especially if the bile ducts are not draining well.
Pancreatitis (inflammation of the pancreas) occurs in 3% to 7% of all patients who undergo ERCP. Aspiration may occur when food from the stomach refluxes into the back of the throat and is inhaled, causing difficulty breathing or pneumonia. If biopsies were taken during your test, you should follow-up as instructed by your physician to discuss the results.
On initial history and examination, the patient may be jaundiced and blood tests may reveal abnormal liver function and raised bilirubin. An ultrasound may show dilated bile ducts within the liver which is suggestive of downstream obstruction.
Finally, contrast may be injected into the biliary tree in order to demonstrate the site of blockage and to potentially treat the obstruction. An obstructed biliary tree may lead to problems such as jaundice, liver failure or infection.
In some cases, a metallic stent is then deployed across the narrowed bile duct in order to hold it open and to restore flow of bile from the liver to the bowel. Using the latest minimally invasive image-guided techniques and applying our specialist vascular knowledge, Sydney Medical Interventions plays a pivotal role in providing patients with minimally invasive options as an alternative to more radical procedures and open surgery. A biliary stricture is any narrowing of the bile duct, the tube that carries bile between the liver, gallbladder and duodenum of the small intestine. Inflammation can then lead to the deposition of collagen resulting in scarring of the bile ducts. A slight narrowing of the bile duct may not hamper the flow of bile and therefore the patient is asymptomatic. Fatty deposits in the skin (xanthomas) and wasting is more likely to occur in severe and prolonged cases. Surgery – post-operatively especially after surgical removal of the gallbladder (cholecystectomy). The clinical features alone are usually insufficient to reach a conclusive diagnosis of biliary strictures and various diagnostic investigations are necessary. Ask a Doctor Online Now!The treatment of biliary strictures is directed at the underlying cause.
Surgical procedures are aimed at removing the bile duct narrowing and allowing for the bile flow to be restored (decompression). Please note that any information or feedback on this website is not intended to replace a consultation with a health care professional and will not constitute a medical diagnosis. Cancerous LesionsIndividuals with cancerous lesions need a multidisciplinary approach from the onset of their work-up. Hepatobiliary and pancreas diseases - disorders of the liver, bile ducts, gallbladder and pancreas - form a complex set of medical problems whose treatment often requires equally challenging surgical procedures. California Pacific Medical Center, part of the Sutter Health networkOpens new window, offers specialized care in liver and hepatobiliary and pancreas disease. Although surgical removal of the gallbladder is considered the best option for treating gallstones, medications that help to dissolve gallstones are sometimes recommended for patients who are unsuitable for surgery. Diarrhea, a common side effect of chenodiol, can be avoided by taking low doses of the drug at the early stage of the treatment. Antacids containing aluminum and cholesterol lowering drugs may reduce absorption of chenodiol. Absorption of ursodiol may be impaired by antacids containing aluminum and certain cholesterol reducing drugs. ERCP is used to treat problems of the pancreas or bile ducts that can cause abdominal pain and jaundice. To begin, patients receive a local anesthetic, either gargled or sprayed on the back of the throat. Arrange for a ride home, as ERCP involves sedation and you should not drive for the remainder of the day.
Schedule Your Appointment TodayIf you’re experiencing symptoms or have concerns about your digestive health, call us today at:888-286-0210or request an appointment online. Northeast Digestive Health Center offers an interactive, secure online portal for patients. WHAT IS ERCP?ERCP is the  acronym for Endoscopic Retrograde Cholangio-Pancreatography, a procedure that enables your gastroenterologist to examine the pancreatic and bile ducts under IV sedation. ERCP may be used before or after gallbladder surgery to assist in the performance of that operation. ERCP is safe when performed by gastroenterologists who have had specific training and are experienced in this specialized endoscopic procedure.
Note: Many of our articles have direct quotes from sources you can cite, within the Wikipedia article! The text of the above Wikipedia article is available under the Creative Commons Attribution-ShareAlike License. When it comes to basic chemistry, ox bile is remarkably similar to human bile, and this is one of the reasons why it often works as a medicinal aid in people. One of its main roles in a living ox is to help the animal absorb vitamins from food that has been ingested, and these properties hold true when the substance is processed and prepared for human consumption, too.
People who aren’t able to properly pull fats and vitamins out of their food during digestion often end up with constipation and bowel obstructions since the intestines and colon usually depend on fatty oils to process stools. A lack of bile or a production imbalance may lead to wide swings in cholesterol and fat levels in the bloodstream.
Cirrhosis happens when the liver’s tissues stop regenerating and begin turning to thick scar tissue. It is typically prepared for the market either as a loose powder or in pill or capsule form. Med school is primarily funded by the pharma industry; they do not discuss much on the alternative med side. Taurine is a substance made from ox bile (and in some other places) and it is commonly added to these products.
At first I thought it was a scientifically proved treatment, like how diabetics use pig insulin in order to control their blood sugar. The bile ducts are channels, analogous to plumbing, that drain bile from the liver and gallbladder; the pancreatic ducts drain the pancreas.
Endoscope in position in the duodenum, facing the papilla demonstrating the bile duct in green and the pancreatic duct in tan. Image showing sphinctertome at papilla, after sphincterotomy has been cut and guidewire in place in the common bile duct, with a large stone in the bile duct. This step is especially important if you are taking aspirin, blood thinners (warfarin or heparin), clopidogrel, nonsteroidal anti-inflammatory drugs (NSAIDs), insulin, or other medicines for diabetes.
The ERCP procedure will be thoroughly explained and you will be given a chance to ask any questions that you might have.
Antibiotics during the procedure and for a few days following ERCP are indicated in certain patients. This would be felt as more severe abdominal pain that does not get better by belching or passing gas.
While this is a rare complication that may heal on its own, it may be severe, and may even require surgery for repair. This risk is minimized in patients who have fasted for several hours prior to the procedure.
It is a way of visualising the bile ducts (cholangiogram) by puncturing the skin (percutaneous) and transgressing liver tissue (transhepatic).
The bile ducts may be obstructed due to problems within the ducts such as stones, strictures or bile duct malignancy.
A minor narrowing does not significantly impede bile movement and a person may be asymptomatic. When it also obstructs the pancreatic duct, enzymes within the gland may damage it leading to pancreatitis. Blood tests, imaging studies and biopsy may be useful in confirming a diagnosis of  biliary strictures and the possible cause.
Medication may only be effective when it is directed at the cause and cannot treat the stricture itself.


Most of these procedures can be done endoscopically and sometimes during diagnostic investigation of the narrowing. Causes can include cancerous and non-cancerous processes as well as injuries from medical procedures or operations. At California Pacific Medical Center, we have been leaders in hepatobiliary and pancreas surgery since the founding of our liver transplant program in 1988. Excess cholesterol or bilirubin in the bile is usually associated with increased risk of formation of stones in the gallbladder.
Your physician may ask you to skip oral contraceptives and certain lipid lowering medications while using ursodiol for treating gallstones.Diarrhea, stomach upset, dizziness, vomiting, sore throat, back pain, hair loss and joint and muscle pain are possible side effects of ursodiol. This process of dissolving gallstones with the help of an organic solvent is more effective than the aforementioned oral dissolution therapy. Your digestive health provider inserts an endoscope down the esophagus, through the stomach and into the duodenum.
Convenient and easy to use, the patient portal lets you request appointments online, email physicians, view test results, update personal medical records and even complete paperwork before your first visit with us! A bendable, lighted tube (endoscope) about the thickness of your index finger is placed through your mouth into your stomach and top part of the small intestine (duodenum). Most health care professionals consider ox bile a form of “alternative medicine.” This doesn’t mean that it is less effective than other more streamlined pharmaceutical treatments, but it does tend to be less popular and is not always widely accepted. One of the primary ways it can be used is to assist the body in the breaking down of fats and the assimilation of vitamins A, D, E, and K. When people take a bit of the extract with food they are often able to better digest some of the more complex nutrients and minerals, which in turn contributes to better health and overall feelings of fullness and satiety. When these are missing or inadequate, the result is often a dense mass that is difficult if not impossible to pass.
This is a contributing factor in the formation of gallstones, or calcified obstructions of the gallbladder.
Manufacturers must strike a balance between killing harmful bacteria and damaging the chemical integrity of the compound. There isn’t usually any uniform way to purchase the supplement, and dosages can vary widely from manufacturer to manufacturer. As with any medication, it’s usually a good idea for people to get an official opinion before self-diagnosing or self-dosing.
Cow heart valves are also used to replace damaged or worn out human heart valves I believe so it is not so far fetched that someone who is unable to produce their own bile might need to replace it with animal bile.
Both types of ducts empty into the duodenum, which is the first part of the small intestine. However, other reasons can include finding causes of persistent pain in the upper abdomen on the right side, looking for causes of acute pancreatitis (acute inflammation of the pancreas) and to relieve obstruction of the bile duct caused by tumors such as pancreas cancer. First, you will be adequately sedated to the point of appearing asleep (often referred to as “conscious sedation” or “moderate sedation”). An intravenous (IV) line will be placed in order to provide IV fluids, sedating medications, and possibly antibiotics. A small plastic mouthpiece will be placed in your mouth to help protect your teeth and gums. If it occurs during the procedure, it can be treated with a variety of endoscopic techniques, including placement of hemoclips, injection of epinephrine (which constricts blood vessels), or use of cautery. While most post-ERCP pancreatitis is mild, rarely, it can be severe and life-threatening, requiring hospitalization.
This form of access to the biliary tree enables minimally invasive intervention such as dilation and stenting of the biliary tree. They may also be obstructed due to extrinsic compression from causes such as masses within adjacent organs like the liver, stomach, pancreas or enlarged lymph glands.
Initially, a catheter is placed through the skin into the bile ducts using a combination of ultrasound or X-rays.
It is only with a severe degree of obstruction or even complete blockage that symptoms arise.
The bile is manufactured by the liver cells, collects in channels within the liver (hepatic canaliculi) and drains into ducts within the liver (intrahepatic ducts). The scar tissue can then constrict the duct wall or thicken the wall leading to a narrowing.
The symptoms associated with biliary strictures become noticeable once the narrowing reaches the point that the movement of bile is impeded. Surgery is usually necessary when conservative management and medical treatment of the underlying cause is not sufficient to resolve the narrowing.
It is important to note that these procedures only aim to relive the bile duct blockage but does not usually attend to the underlying cause. Most commonly, biliary leaks are the result of medical procedures and operations, or traumatic injuries to the biliary system. Once diagnosed, optimal management is discussed with surgeons, interventionalists and oncologists.
People with gallstones who are reluctant to undergo surgery or have a high risk of developing health complication following surgery are occasionally recommended chenodiol for treating gallstones.
It takes about five to twelve hours to dissolve gallstone with the help of MTBE injections.
In the duodenum a small opening is identified (ampulla) and a small plastic tube (cannula) is passed through the endoscope and into this opening.
Tumours, both cancerous and noncancerous, can be diagnosed and then treated with indwelling plastic tubes that are used to bypass a blockage of the bile duct. Pancreatitis due to irritation of the pancreatic duct by the X-ray contrast material or cannula is the most common complication. Bile preparations aren’t usually subjected to the same rigorous testing and regulatory processes as most pharmaceuticals are, either, which can lead to a greater degree of variation when it comes to purity and efficacy.
Healthy people are usually able to do this on their own, but those who don’t produce enough bile or who have other imbalances in their blood chemistry often need a bit of extra help. In the absence of bile food can still be digested, but a lot of the nutritive value is lost or flushed out before it can be useful.
People who consume the ox extract in these cases often do so to promote digestive health, which can cure the root cause of their constipation; relief is often somewhat slow in coming, though. People who are prone to this condition sometimes supplement with bile from oxen as a way of restoring proper liver functionality and preventing painful stones. Supplementing with ox product may help patients overcome some of the disease’s side effects, though it is rarely able to offer anything near a cure. To hot and things tend to become ineffective, but not hot enough and toxins and other harmful substances can thrive.
Anyone interested in starting a regimen is usually advised to get specific recommendations from a healthcare provider when it comes to which brand or preparation to choose, and how much to take. Bile produced from oxen may be “all natural,” but this doesn’t mean that it should be taken lightly or without regard for its potentially serious health implications. I asked my doctor (surgeon) what I could take when my gallbladder was removed) and she said there is nothing out there. Often, in many of these situations, an ultrasound of the abdomen or a special kind of MRI study called MRCP may be performed to obtain preliminary information that can guide the need for ERCP.
Usually this is achieved with intravenous medications, but sometimes general anesthesia is necessary. Depending on the unit and the situation, you may either undergo conscious sedation (moderate sedation), or general anesthesia.
Once sedation is administered, you should expect to be comfortable and asleep or very relaxed. Dr Goh has been on the faculty of the Annual Hepatobiliary workshop at Royal Prince Alfred Hospital.
The catheter can then be attached to a drainage bag in order to decompress the biliary tree. Although strictures can cause severe discomfort and  serious complications, it is usually not fatal.
Sometimes physical obstructions in the bile duct, like gallstones or biliary duct stones, can block the flow of bile even without inflammation.
The clinical presentation also depends on the complications that develop with biliary strictures. Radiation and chemotherapy are other therapeutic measures that may be considered for malignant causes of biliary strictures. Given the many reasons for bile duct obstruction, a multidisciplinary approach is needed to effectively diagnose and treat patients. If the patient is deemed a surgical candidate, physicians pursue resection of the lesion followed by biliary reconstruction. Annually, our physicians provide care to some 4,000 hepatobiliary and pancreas patients, both in San Francisco and at our network of outreach sites in California and Nevada. Overweight or obese people losing weight rapidly can avoid the risk of developing gallstones with the help of ursodiol. A tube (catheter) is then slid through the endoscopy and guided through the papillary opening. Dye (contrast material) is injected and X-rays are taken to study the ducts of the pancreas and liver. Complications from gallbladder surgery can also sometimes be diagnosed and treated with ERCP.
Laxatives or bulk fiber are usually more effective immediate solutions, and are often taken alongside bile for more comprehensive treatment. The extract can also sometimes speed recovery in people who have undergone a cholecystectomy, which is the surgical removal of the gallbladder.
It sounds gross, but due to mineral deficits, my doc was going to recycle this through a stomach tube. Also the amounts they put in energy drinks are usually not enough to really do anything anyway. The endoscope or tube is placed into the mouth and advanced into the esophagus, stomach, and to the point in the duodenum where the bile duct enters; this is known as the papilla. General anesthesia is administered by an anesthesia specialist and may require a breathing tube since it is a deeper level of sedation. Sometimes it may be due to cancer but a fairly common benign cause is injury to the duct after gallbladder surgery and diagnostic investigations of the biliary tree. The underlying cause is instead more likely to be the cause of death particularly in the event of cancer.
However, benign causes of biliary strictures does not mean that it is due to benign (non-cancerous) cause. Malignancies of the bile duct or around the duct which then compresses it can also be the cause of a stricture.


Sometimes the diseased portion of the bile duct is removed and the remaining portion of the duct joined to the small intestine.
At California Pacific Medical Center, our team of surgeons, radiologists, interventional endoscopists and oncologists offer treatment for a wide variety of biliary obstruction cases. Interventional approaches (interventional radiologic procedures and interventional endoscopic procedures) are able to treat a majority of the injuries.
For patients requiring hospitalization, we have a dedicated critical care liver unit, hospitalists who specialize in hepatobiliary disease, physician assistants, on-call anesthesia staff and a specialized O.R. Why is an ERCP performed?ERCP is most commonly performed to diagnose conditions of the pancreas or bile ducts and is also used to treat those conditions.
In patients with suspected or known pancreatic disease, ERCP will help determine the need for surgery or the best type of surgical procedure to be performed. Irritation to the vein in which medications were given is uncommon, but there may be a tender lump lasting a few weeks. It’s relatively easy to live normally without this gland, but people in this position often need to pay special attention to diet and nutrient absorption in order to stay healthy. A plastic catheter (thin tube) is threaded through the scope to come out its tip and then is maneuvered to enter the papilla and the ducts. You may feel groggy or have difficulty concentrating, so patients are advised to rest for the remainder of the day. Bile can be stored in the gallbladder until it is ready to be expelled into the small intestine. CancerousThe presence of a cancerous lesion(s) within the hepatobiliary system can also lead to bile duct obstruction.
Interventional approaches are usually used in cases in which the patient is not a surgical candidate and the risk of the operation is outweighed by the benefits afforded by surgical intervention (Figure 3). To realize the maximum benefit of the drug, it should be taken daily, twice a day, for a prolonged period. It is used to evaluate symptoms suggestive of disease in these organs, or to further clarify abnormal results from blood tests or imaging tests such as ultrasound or CT scan.
Warm moist towels will help relieve this discomfort.If your ERCP included a therapeutic procedure such as removal of stones or placement of a stent (drain), there are additional small risks of bleeding or perforation (making a hole in the intestine). When left untreated it can lead to complications ranging from gallstones to a bile duct infection and even liver abscess. The cystic duct and hepatic duct join to form the common bile duct which in turn joins with the pancreatic duct at the ampulla of Vater.
Instead it arises from severe or prolonged inflammation of the bile duct.  Inflammation usually arises from an injury, usually associated with surgery or diagnostic investigations. In these cases, optimal treatment requires a multimodal approach that includes a surgeon, oncologist and interventionalist (endoscopist and radiologist) and radiation oncologists. Biliary Leaks by LocationHepaticBile duct leaks can occur after a liver operation or trauma in which a portion of the liver is removed or injured. The mainstay of surgical treatment is to first remove the area of stricture, then reconstruct the biliary system.
Cancer Navigation ServiceOur Cancer Care Navigation Service provides individuals and families assistance with appointment scheduling, patient education and support service referral. The exact dosage of the drug depends on the response to treatment, body weight and condition of health.
The most common reasons to do ERCP include abdominal pain, weight loss, jaundice, or an ultrasound or CT scan that shows stones or a mass in these organs. By examining the ducts in this way, information about blockages, stones, tumors, or irregularities of the ducts can be gathered.
Depending upon how your initial recovery goes, you may be admitted to the hospital overnight for observation. Liver LesionsCancers of the bile ducts within the liver, liver cancers or cancers metastatic to the liver can cause obstruction of the bile duct system. Your stomach must be empty, so you should not eat or drink anything for approximately 8 hours before the examination. If abnormalities are found, the doctor can perform techniques to repair or improve the condition. Over time this can cause damage to the liver and in some instances even progress to liver failure. The Roux limb is connected to the remnant bile duct outside the liver (Roux-en-Y choledochojejunostomy) or the bile ducts within the liver (Roux-en-Y hepaticojejunostomy) (Fig. Genetic Risk AssessmentThe Cancer Genetic Risk Assessment Program at California Pacific offers individuals with a personal or family history pancreatic cancer the opportunity to learn more about the genetic nature of their disease and whether they may be predisposed to other cancers which they could monitor.
Your gastroenterologist will be more specific about the time to begin fasting depending on the time of day that your test is scheduled. For example, if stones are seen, the papilla can be widened or cut open and stones may be removed from the duct. Prior to treatment of the obstruction, a full work-up of the lesion to determine the extent of disease is necessary.
Individuals meet with our genetic counselor during which an evaluation of onea€™s medical and family history is performed, as well as a detailed risk assessment and genetic education.
To prevent recurrent formation of gallstones, ursodiol should be taken for a prolonged period, even after the symptoms of gallstones subside.
The papilla contains a sphincter muscle that is often cut using cautery (the passage of electric current) during the procedure (sphincterotomy), which allows for better duct drainage.
Additionally, a biopsy of the lesion may be needed, which is usually performed with CT or ultrasound guidance. Treatment usually involves placement of a drainage catheter directly into the biloma by the interventional radiologist to drain the collection. A genetic risk assessment may assist in medical management decisions such as aggressive cancer screening and preventive measures.
Medication use such as aspirin, Vitamin E, non-steroidal anti-inflammatories, blood thinners and insulin should be discussed with your gastroenterologist prior to the examination as well as any other medication you might be taking.
The interventional endoscopist then places a stent into the biliary system adjacent to the leaking duct to allow bile to drain via the normal route rather than leak out.
It is therefore best to inform your gastroenterologist of any allergies to medications, iodine, or shellfish. It is essential that you alert your gastroenterologist if you require antibiotics prior to undergoing dental procedures, since you may also require antibiotics prior to ERCP.
Interventional approaches can be used to treat the obstruction if the patient is not a surgical candidate.Extrahepatic Bile Duct CancersAn extrahepatic bile duct cancer refers to all cancers that arise within the bile duct system below the liver (Figure 1b).
Common bile ductCommon bile duct injuries can occur during gallbladder operations or endoscopic interventions of the common bile duct. Also, if you have any major diseases, such as heart or lung disease that may require special attention during the procedure, discuss this with your gastroenterologist. During a gallbladder operation, the common bile duct can be injured or a clip placed on the cystic duct may fall off at a later time leading to bile leakage.
To make the examination comfortable, you will be sedated during the procedure, and, therefore, will need someone to drive you home afterward. If the injury is noticed during the initial operation, the surgeon will fix the bile duct injury with a Roux-en-Y choledochojejunostomy. Sedatives will affect your judgment and reflexes for the rest of the day, so you should not drive or operate machinery until the next day. Brushings and subsequent pathological examination of the bile duct help with the diagnosis.
For leaks that are not noticed at the original operation, treatment is similar to that described above for hepatic injuries. Common bile duct (at the level of the pancreas) The pancreas is also a site of common bile duct injuries, usually as the result of interventional endoscopy.
Your throat will be sprayed with a local anesthetic before the test begins to numb your throat and prevent gagging. Pancreatic CancersPancreatic cancers can cause obstruction of the bile duct just as it enters the intestine (Figure 1b). While you are lying in a comfortable position on an X-ray table, an endoscope will be gently passed through your mouth, down your esophagus, and into your stomach and duodenum. Treatment of this patient requires a multidisciplinary approach encompassing surgeons, oncologists, radiologists and radiation oncologists for optimal outcome.
Non-CancerousIatrogenicBiliary stricturing (narrowing) or obstruction may be the result of an injury sustained during a medical procedure.
You may feel temporarily bloated during and after the procedure due to the air used to inflate the duodenum. Bile duct injuries that do not cause bile spillage but cause strictures are usually treated when symptoms arise. As X-ray contrast material is injected into the pancreatic or bile ducts, you may feel some minor discomfort. You will be monitored in the endoscopy area for 1-2 hours until the effects of the sedatives have worn off. Cholelithiasis (Gall Stones) and Biliary StonesGall stones or biliary stones can pass from the gallbladder or liver, respectively, into the common bile duct and proceed into the small intestine depending on their size.
As they pass through the biliary tree, these stones may cause obstructions if they are lodged in the bile duct. You will be able to resume your diet and take your routine medication after you leave the endoscopy area, unless otherwise instructed. Additionally, strictures may occur due to repeated trauma to the bile duct lining (Figure 2). Your gastroenterologist will usually inform you of your test results on the day of the procedure. Interventional endoscopists can extract lodged stones in the common bile duct tree by performing a procedure called ERCP (endoscopic retrograde cholangiopancreatography). Biopsy results take several days to return, and you should make arrangements with your gastroenterologist to get these results. Similarly, strictures can be treated by an interventional endoscopist or interventional radiologist, depending on the site of the problem and issues related to the patienta€™s surgical candidacy. After stone removal, further operations may be necessary to remove the source of the stones (gall bladder or part of the liver).



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