| Discussion in 'All Categories' started by Sushil - Feb 4th, 2012 12:39 pm. | |
Sushil
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My father have CBD stone , The common bile duct is diated and mesures aproximately 17.8 mms in maximum diameter. there are multiple hypointense filling defects in the distal and mid CBD suggestive of calculi Gall bladder is not visualised .The first time he has undergone two kidney stones, and the second time gall blader , please note that this finding & suggest me Thanks with regard Sushil Nautiyal |
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re: CBD stone
by Dr M.K. Gupta -
Feb 4th, 2012
10:54 pm
#1
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Dr M.K. Gupta
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Dear Mr Sushil Your father need ERCP. Endoscopic retrograde cholangiopancreatography (ERCP) is really a technique that combines using endoscopy and fluoroscopy to identify and treat certain problems from the biliary or pancreatic ductal systems. With the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts within the biliary tree and pancreas so they can be seen on X-rays. ERCP can be used primarily to identify and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP can be carried out for diagnostic and therapeutic reasons, although the development of safer and relatively non-invasive investigations such as magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound has meant that ERCP is now rarely performed without therapeutic intent. Between 10% to 18% of patients undergoing cholecystectomy for gallstones have common bile duct stones. Treatment options of these stones include pre- or post-operative endoscopy (endoscopic retrograde cholangiopancreatography), open surgery, or laparoscopic bile duct exploration. Within the era of open cholecystectomy, open bile duct surgery was significantly better than endoscopic retrograde cholangiopancreatography in achieving common bile duct stone clearance. A trend towards decreased mortality seemed to be surprisingly seen in the surgical arm. Laparoscopic cholecystectomy with simultaneous laparoscopic bile duct exploration appear to be as safe so that as efficient as endoscopic retrograde cholangiopancreatography, and avoid an additional procedure. Because the introduction of laparoscopic techniques, the control over choledocholithiasis is within a situation of evolution. Throughout the early phase of laparoscopic cholecystectomy, intra-operative cholangiography was infrequently performed, and pre-operative diagnostic and therapeutic ERCP became the standard for patients suspected of harbouring a biliary duct stone. Post-operative ES became the preferred use of treating patients with CBD stones encountered at operation or discovered afterwards. Consequently, ERCP and ES acquired a prominent position within the management of choledocholithiasis, because they were the only real alternative to open choledocholithotomy. With regards M.K. Gupta |
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