Head, Department of Gastroenterology & Hepatology at Manipal Hospital, Dwarka, New Delhi.
Endoscopic Retrograde Cholangio-pancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy(X-ray) to diagnose and treat certain problems of the biliary or pancreatic ductal systems. Through the special side-viewing endoscope, the physician can see the inside of the food pipe, stomach and duodenum. The bile duct and pancreatic duct open together into the duodenum (see figure below). The doctor can inject dye into the ducts to visualize them on X-ray. Also, through the working channel in the endoscope one can gain access into the desired duct by using special hydrophilic guide wires. The wire is then used to guide various instruments to perform procedures like bile duct stone removal and stent placement.
ERCP is usually carried out as a day-care procedure. However, at times hospitalization is required for observation following the procedure. Your stomach must be empty. So, for an AM procedure, do not eat or drink anything after midnight on the day before ERCP. For a PM procedure, do not take food or drink after 7 AM on the day of the examination. Do tell your doctor if you are suffering from diabetes, hypertension, heart ailment or any other disease so that suitable precautions are taken. If you are taking prescribed medication, do discuss with your doctor as the medication may interfere with the procedure or clotting of blood. It is important to tell the doctor about any allergies or bad reactions to medication. Your doctor shall invariably carry out a set of blood tests, ECG and X-ray Chest to determine your suitability for the procedure. Also, some form of antibiotic is administered to fight or prevent infections and vitamin K is given aid clotting of blood.
The staff will explain the procedure and answer your questions. You will be asked to sign a consent form, giving permission for the examination. You shall be escorted to the changing room, where you can get into slippers and change into a suitable dress. It is a good idea to visit the wash room prior to the procedure. You will be asked to remove your dentures, spectacles and any sharp objects like pens. Valuables, if any, should be handed over to the accompanying person or placed in the locker in the changing room and the key handed over to the nurse on duty. As the procedure takes 15 to 30 minutes or longer, ERCP is usually done under light anaesthesia to avoid any discomfort. An intravenous (IV) access line is started prior to your examination so that suitable medication can be easily administered. While in a comfortable position on your left side, a guard will be placed in the mouth to protect your teeth and the doctor will gently pass the endoscope through your mouth, and down your throat. A. If required, biopsies may be taken during the examination. The rest of the procedure shall depend upon the anatomy and the indication for ERCP. In most cases, once the bile duct is accessed with a guide wire, the opening of the bile duct is cut open electrically, a procedure known as Papillotomy. At times, the opening of the bile duct may be further increased in size by inflating a balloon, This enables your physician to remove stones from the bile duct by using a dormia basket or balloon. Larger stones have to be crushed with a lithotriptor prior to endoscopic removal. Any obstructions in the biliary system may be dilated with boogies or balloons. Samples for endoscopic brush cytology may be collected and suitable stents placed in the biliary system. Similar interventions can be done for the pancreatic duct. Following the procedure, if there is increased risk of pancreatitis, diclofenac suppositories may be placed in the rectum by the nurse. The endoscopic view of the procedure shall be recorded.
Once your ERCP is completed, you will be shifted to a recovery room for observation for a period ranging from 1 to 2 hours. If major interventions have been done the doctor may decide to hospitalize you for observation and administration of intravenous antibiotics and other medication. Your report will be ready by the time you change and are ready to go home or shifting to the ward. As you would have received a sedative injection, a companion must be available to drive you home. For the remainder of the day you should not drive a car, operate machinery or make important decisions as the sedation impairs your reflexes and judgement. Before you are discharged, you will be given instructions regarding problems to be aware of after the procedure, treatment, diet, and follow up appointments if needed.
After the ERCP, you should not expect to be uncomfortable but:-
ERCP is generally safe. Complications can occur but are rare as the test is being performed by physicians with specialized training and years of experience in this procedure. Bleeding may occur from the site of papillotomy. It is usually minimal and rarely requires blood transfusions or surgery. Irritation of the pancreas may lead to pancreatitis resulting in pain over upper abdomen and vomiting. This is usually mild and settles down after a few days. Other potential risks include a reaction to the sedatives used and complications from heart or lung diseases. Major complications e.g. perforation (a tear that might require surgery for repair) are very uncommon. It is important for you to recognize early signs of any possible complications. If you begin to run a fever after the test, begin to have trouble swallowing, or have increasing throat, chest or abdominal pain, let your doctor know about it promptly.
Upper GI Endoscopy is a procedure that enables your physician to examine the lining of the upper part of the gastrointestinal tract, i.e. the esophagus (food pipe), stomach and duodenum(part of the small intestine) by using a thin flexible tube with its own optical fibres, lens and light source. Upper GI Endoscopy is the investigation of choice for detecting inflammation, ulcer, or tumour of the esophagus, stomach and duodenum. Biopsies, which are painless, may be taken during the procedure for many reasons and do not necessarily mean that cancer is suspected. Most often a biopsy is done to detect an organism called Helicobacter pylori from the stomach using a test called as Rapid Urease Test.
Besides being a diagnostic modality of choice, Upper GI endoscopy is used to treat several conditions of the upper gastrointestinal tract with little or no discomfort. A variety of instruments can be passed through a working channel in the endoscope thus enabling the doctor to remove ingested foreign bodies, stretch narrowed areas with balloons or boogies and treat upper gastrointestinal bleeding. Thus therapeutic endoscopy can be both life-saving and surgery-saving.
The procedure is usually carried out as an out-patient. Your stomach must be empty, so do not eat anything for 6 hours prior to the procedure. One may take water till 2 hours before the procedure. Do tell your doctor if you are suffering from diabetes, hypertension, heart ailment or any other disease so that suitable precautions are taken. If you are taking prescribed medication, do discuss with your doctor as the medication may interfere with the procedure or clotting of blood. It is important to tell the doctor about any allergies or bad reactions to medication.
The staff will explain the procedure and answer your questions. You will be asked to sign a consent form, giving permission for the examination. You shall be escorted to the procedure room. It is a good idea to visit the wash room prior to the procedure. You will be asked to remove your dentures, spectacles, valuables and any sharp objects like pens. Usually endoscopy is done following application of a local anaesthetic spray on to your throat to make it numb. If you are very apprehensive, intra-venous injection for sedation is possible in a hospital setting. While in a comfortable position on your left side, a guard will be placed in the mouth to protect your teeth and the doctor will gently pass the endoscope through your mouth, and down your throat. A. The instrument may cause slight discomfort but will not interfere with your breathing, nor cause any pain. The examination usually takes 2 to 5 minutes and it is a good idea to focus on deep breathing thereby avoid retching. The instrument is sterilized as per international standards.
You should not attempt to eat or drink until your swallowing reflex is normal (at least 30 minutes). After this you may return to your regular diet unless otherwise instructed. You may feel slightly bloated for some time due to the air which has been introduced through the endoscope. Your report will be ready and printed by the time you change and are ready to go home.
Endoscopy is generally safe. Complications can occur but are rare as the test is being performed by physicians with specialized training and years of experience in this procedure. Bleeding may occur from a biopsy site or where a polyp was removed. It is usually minimal and rarely requires blood transfusions or surgery. Other potential risks include complications from heart or lung diseases. Major complications e.g. perforation (a tear that might require surgery for repair) are very uncommon. It is important for you to recognize early signs of any possible complications. If you begin to run a fever after the test, begin to have trouble swallowing, or have increasing throat, chest or abdominal pain, let your doctor know about it promptly.
Colonoscopy is a procedure that enables your physician to examine the lining of the lower gastrointestinal tract, i.e., the large intestine (colon) and, at times, the last part of small intestine (terminal ileum) by using a thin flexible tube with its own optical fibers, lens and light source. Colonoscopy is the investigation of choice for detecting inflammation, ulcer, or tumor of the colon and terminal ileum. Biopsies, which are painless, may be taken during the procedure for many reasons and do not necessarily mean that cancer is suspected.
Besides being a diagnostic modality of choice, colonoscopy is used to treat several conditions of the lower gastrointestinal tract with little discomfort. A variety of instruments can be passed through a working channel in the endoscope thus enabling the doctor to remove polyps, stretch narrowed areas with balloons or boogies and treat lower gastrointestinal bleeding. Thus therapeutic colonoscopy can be both life-saving and surgery-saving.
The procedure is usually carried out as an outpatient. The most important part of a successful colonoscopy is the preparation. This means making sure that the entire stool in your colon is cleaned out and all that is left is some clear liquid. There are several ways of preparing the colon and your physician shall choose the one that fits best for you. Your cooperation is important.
The staff will explain the procedure and answer your questions. You will be asked to sign a consent form, giving permission for the examination. You shall be escorted to the changing room, where you can get into slippers and change into a suitable dress. It is a good idea to visit the washroom prior to the procedure. You will be asked to remove your denture, spectacles, valuables and any sharp objects like pens. You shall be lying on your left side and following a rectal examination, the doctor will gently insert the colonoscopeinto your rectum and guide it up into the colon. During the procedure, you may be move to different positions to assist the doctor in examining a particular area. You may feel some cramping during the examination. This is normal, as small amounts of air are inserted through the colonoscope into your bowel to allow your doctor to see well. It is important for you to let the doctor or nurse know if you have discomfort so additional medication may be given to you. It is important for you to listen to any instructions given by the doctor or nurse during the procedure, as they will help keep you comfortable. The whole procedure usually takes 10 to 20 minutes.
Your report will be ready and printed by the time you change to go home. After the colonoscopy, you should not expect to be uncomfortable but you may have abdominal discomfort. This is most likely due to air put in during the colonoscopy and should not last long. Lying down flat on your tummy shall hasten the passage of extra air from the rectum and make you comfortable. Before you are discharged, you will be given instructions regarding problems to be aware of after the procedure, results of the exam, treatment, diet, and follow up appointments if needed. If you experience persistent abdominal pain, bloating, rectal bleeding, fever, nausea, or vomiting do should contact your doctor immediately.
Colonoscopy is generally safe. Complications can occur but are rare as the test is being performed by physicians with specialized training and years of experience in this procedure. Bleeding may occur from a biopsy site or where a polyp was removed. It is usually minimal and rarely requires blood transfusions or surgery. Major complications e.g. perforation (a tear that might require surgery for repair) are very uncommon. It is important for you to recognize early signs of any possible complications. If you begin to run a fever after the test, begin to have abdominal pain, vomiting or bloating, let your doctor know about it promptly.
This is a rapid, non-invasive and painless new test used for assessment of liver stiffness. With the latest version of Fibroscan, available at Fortis Memorial Research Institute, Gurgaon, it is also possible to measure liver fat.
Long-term damage to the liver results in the liver becoming stiff due to a process called Fibrosis. Fibroscanis used to measure the elasticity or stiffness and fat content of the live. During the examination you lie on your back with your right arm raised behind your head. The operator applies and a water-based gel to your skin and places the Fibroscan probe on your chest with a little pressure. By pressing a button, the ultrasound probe sends a shear wave into the liver. The on-board computer automatically processes this data and the values are shown on the screen. Ten such readings are measured and the average taken.
An Ultrasound Scan can detect gallstones, tumours, cysts, abscesses and other structural lesions of the liver. However it is not able to detect significant liver fibrosis, or hardening of the liver, until a very advanced stage called Cirrhosis, or estimate liver fat accurately, especially in the early stages.
Any person who:
No, It is a non-invasive test that is pain free and is like taking a picture of the liver. When the ultrasound waves are deployed you will feel a gentle vibration against the surface of your skin.
You should not undergo test if you:
After your fibrosan procedure:
You can go home, you do not need to have anyone to escart you can eat and drink normally.
Fibroscan takes about 10 minutes and the results are printed and made available immediately.
The patient can go back home or to work immediatelyas there is no pain, and no sedation is required for his procedure.
We have several paramedical staff that are trained and certified toperform the Fibroscan. However the test shall be analysed by one of our expert doctors.
No, our fiberscan has both regular and XL probes.
In the past, the only method for determining liver stiffness was a liver Biopsy. Thisentailed putting a needle in to the liver to obtain a small piece for evaluation. However a Biopsy is invasive and may be associated with some complications, albeit rare, such as pain at the site and internal bleeding. But now with fibroscan, we have a pain free, risk free and convenient way to measure Liver Fibrosis.
Yes, a follow up scan helps in determining the dynamics of a particular liver. Condition over a period of time, usually after a year. Monitoring the stiffness or fat scores tell us whether the condition is improving, static or worsening, thus necessitating a change in treatment.
The result is given as a specific score in kilopascals (KPa) which is the median score of at least 10 readings. In viral hepatitis, a score of less than 7 means no or insignificant liver fibrosis: a score of more than 12.5k pa is severe fibrosis or cirrhosis and the results between this suggest moderate fibrosis.
