ERCP stands for endoscopic retrograde cholangio – pancreatography.
It’s an endoscopic test for treatment and diagnosis for diseases related to biliary (bile) and pancreatic duct.
How is our normal biliary and pancreatic system?
The normal biliary system has – gallbladder, (it is a sac that stores bile produced by the liver) and its draining tube called the common bile duct (CBD).
The pancreatic system has pancreas and its draining tube called the pancreatic duct.
Both bile juice (through common bile duct) and pancreatic juice through pancreatic duct enter duodenum through an opening called ampulla or papilla. These two juices are required for the digestion of food.
Stones are normally produced in the gallbladder, and some of them may slip to common bile duct to produce jaundice.
How ERCP is done?
It’s done by an endoscope passed through the mouth to the duodenum.
Bile duct or pancreatic duct is entered through this scope via ampulla or papilla by various accessories – stones are pulled into intestine – then they pass out.
The procedure is done by a trained gastroenterologist. Also, the procedure is performed under sedation (either conscious sedation or general anaesthesia) - as per the preference of gastroenterologist.
Who are patients need ERCP?
In an individual with stone slipped into common bile duct from the gallbladder.
Stricture or narrowing of common bile duct with jaundice.
Cancers of bile or pancreatic duct.
Pancreatic duct stones or strictures.
Pseudocyst – pus collection after a severe attack of pancreatitis.
Do I need to get admitted for ERCP?
Most procedures can be done as a daycare procedure. But if planned for laparoscopic cholecystectomy after ERCP, needs admission. If severe infection or cancers of the biliary system, then again needs admission.
What are the precautions needed?
ERCP requires an empty stomach – at least 6 hours. If you are on blood thinners (like ecosprin, clopidogrel, or warfarin) please inform doctors.
What happens after ERCP?
An individual is observed for 4 hours post ERCP for any pain abdomen, fever, vomiting or abdominal distention. If everything is normal, can start with a liquid diet and can be discharged.
What are the side effects of ERCP?
Every medical procedure carries some complications. In 95% of cases, it is a safe procedure. Main complications are posted ERCP pancreatitis, bleeding and perforation. If these things happen – then individual needs more days of hospitalization.
What is colonoscopy?
Colonoscopy is an endoscopic test to see colon (large intestine).
Who are individuals who require colonoscopy?
If you have chronic diarrhoea (loose stools), constipation, blood in the stool, screening for colon cancer, anorexia, weight loss, piles, fissures, for removal of polyps and taking the biopsy.
How colonoscopy is done?
Normally, the large intestine is filled with stools (motion). so a solution is given to drink so that individual will have 8-10 times motion. Then an endoscope is passed through the anus to see large intestine.
What is the preparation needed?
If you are diabetic, on the day of colonoscopy – you should avoid diabetic tablets or insulin.
Bp and thyroid medications to be taken in the morning with one glass of water.
Reach hospital after taking liquid diet like juice/tender coconut water/buttermilk on the day of the colonoscopy.
It is better to avoid breakfast on the morning of colonoscopy.
On the previous night, you can have a normal diet, better to avoid ragi containing foods.
If you are on blood thinners (like ecosprin) please inform the doctor.
Do I need to get admitted to the hospital?
No, it is a daycare procedure. Admission is not usually required
Drinking of colonoscopy solution takes 2 hours. After that, procedure time varies from 15 mins to 40 mins. So, the total time in hospital varies from 4 to 5 hours.
Is it a painful procedure?
No. Most colonoscopies are done without sedation (anaesthesia). If you are worried or pain threshold is less – you can ask for sedation. If you receive sedation, an individual has to stay for 2 hours extra for observation. It is preferable not to drive a vehicle on the day of sedation. So that you can ask your friend or relative to be with you, on the day of the procedure.
What happens during a colonoscopy procedure?
During the colonoscopy – doctor may take biopsy. If any polyps are found, can be removed at the same setting - depending upon the individual preferences.
What happens after a colonoscopy?
Usually during colonoscopy - endoscopist will distend with air- so mild abdominal distention can happen. It will improve – if you use the restroom to clear the gas.
Distention is less common now a day – because carbon dioxide is used, instead of air.
After colonoscopy – individual will be observed for any pain/distention/ vomiting. if none of them exists, then you can have normal food.
If someone received sedation or undergone polyp removal – they are observed in the hospital for 2-3 hours.
What are the risks of a colonoscopy?
Generally, it is a safe procedure.
Rarely pain abdomen, abdominal distention, bleeding if polyps/biopsy is taken can happen.
Very rarely perforation can happen.
GERD - Gastroesophageal Reflux Disease
How acidity or GERD happens?
The digestive system has oesophagus, stomach, small and large intestine.
Once we eat food, it goes through the oesophagus and stores in the stomach for 3-4 hours. Digestion of food starts in the stomach with the help of acid, enzymes produced within the stomach. So, acid is very much required for digestion, absorption of a few vitamins.
Most people have reflux of stomach contents into the oesophagus in revere way, multiple times a day, but it itself is not a problem. However, when it is associated with symptoms like heartburn, then is called GERD.
What is the literal meaning of GERD?
G - Means gastro or stomach. E - Esophagus. R - Reflux – Reverse Movement of acid/food from the stomach into the Esophagus. D - Disease.
What are the symptoms of GERD?
Common is heartburn – the burning sensation in the centre of chest and regurgitation or burping.
Less common are nausea, vomiting, saltwater in the mouth.
What are food items to be avoided in GERD?
Citrous items such as –
Lime, orange, tamarind, tomatoes.
Chocolates, soft drinks.
Smoking and alcohol.
Any tablets or medical conditions can worsen GERD?
If you have diabetes, thyroid problem, overweight- then GERD can be more. So adequate control of sugars, regular thyroid tablets and weight reduction, helps in improvement of GERD.
If you take pain killers, multiple tablets, or blood thinners- then GERD is also common.
How GERD is treated?
Initially, GRED can be treated with tablets called antacids for 3-4 weeks. These tablets to be taken in the morning 30 mins before breakfast.
When to get an endoscopy done?
If symptoms persist after 3-4 weeks of antacids or if you have anorexia, vomiting, severe symptoms, blood in vomiting, weight loss, painful swallowing, difficulty in swallowing, more than 45 years – then endoscopy to be done as soon as possible.
Is endoscopy painful?
No, and it is a very safe procedure. Generally, endoscopy takes about 2 to 4 mins.
What is noted during the endoscopy?
The endoscopist may see oesophagal ulcerations, erosions, loose sphincter (LES), or hiatus hernia or h pylori infection.
I’m not improving even after many days of antacid tablets – then what to do?
If the condition is not improving even after many days of antacid tablets, then better get an endoscopy done – if not done previously.
You can also get hrm- high-resolution oesophagal manometry to rule out oesophagal motility (movement problems) disorders.
As well 24 hours ph study to document reflux as well to decide regarding the need for surgery like laparoscopic fundoplication.