CBD Stone Removal / ERCP
Common bile duct stones (CBDs) may occur in up to 3%–14.7% of all patients for whom cholecystectomy (Gall bladder stone surgery) is preformed. Patients presenting with CBDS have symptoms including biliary colic, jaundice, cholangitis, pancreatitis or may be asymptomatic.
There are several techniques to remove CBD stones and one of the most common technique is to do ERCP for CBD Stones
An endoscopic retrograde cholangiopancreatogram (ERCP) test checks the tubes (ducts) that drain the liver, gallbladder, and pancreas. A flexible lighted scope (endoscope) and X-ray pictures are used. The scope is put through the mouth down the throat. It goes into your esophagus, stomach, and duodenum until it reaches the point where the ducts from the pancreas and gallbladder drain into the duodenum.Its the best time to take X-rays.
ERCP can treat certain problems found during the test. In some cases Dr Rajan Dhingra will perform the procedures then and there by inserting small tools through the scope to:
Take a sample of tissue (biopsy) from an abnormal growth. Then it can be checked for problems and after than best treatment can be given.
Remove a gallstone in the common bile duct.
Open a narrowed bile duct. A narrowed bile duct can be opened by inserting a small wire-mesh or plastic tube (called a stent) in the duct.
Why ERCP is Done
ERCP is best procedure for:
Check lasting belly pain or jaundice.
Find gallstones or diseases of the liver, bile ducts, or pancreas.
Remove gallstones from the common bile duct if they are causing problems. These may include a blockage (obstruction), inflammation or infection of the common bile duct (cholangitis), or pancreatitis.
Open a narrowed bile duct or insert a drain.
Get a tissue sample for further testing (biopsy).
Measure the pressure inside the bile ducts (manometry).
Laparoscopic CBD exploration (LCBDE)
The successful laparoscopic management of CBD stones depends on several factors including surgical expertise, adequate equipment, the biliary anatomy and the number and size of CBD stones. With advancing technology and minimally invasive surgery (laparoscopic biliary surgery) has become safe, efficient, and cost effective. Laparoscopic common bile duct exploration (LCBDE) was associated with successful stone clearance rates ranging from 85% to 95%
During laparoscopic cholecystectomy if common bile ducts stone (CBDSs) are found laparoscopic common bile duct exploration (LCBDE) can be performed. There are two primary methods for LCBDE: trans-cystic (via the cystic duct) and trans-ductal (via choledochotomy). If CBDS are detected at the time of laparoscopic cholecystectomy, the best treatment is a trans-cystic laparoscopic approach during the same operation. If this fails alternate approaches such as intraoperative or postoperative ERCP, laparoscopic choledochotomy, or open CBDE may be used . A trans-cystic approach is generally used for small stones in a small bile duct whereas trans-ductal approach is preferred for large occluding stones in a large duct, intrahepatic stones, or a miniscule or tortuous cystic duct