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Biliary-Pancreatic Disorders and Advanced Endoscopy

Pancreatic diseases are a set of conditions affecting the pancreas, an organ located behind the stomach that produces juices and hormones that help with food digestion and blood sugar regulation. The most common benign pancreatic disease is pancreatitis, which can be either acute (also known as short-term) or chronic (also known as long-term). Pancreatic disease can also be malignant in the case of pancreatic cancer.

Biliary diseases affect the bile ducts and gallbladder, which work to produce and transport bile, a substance that aids the body in digesting fat and transporting waste. Bile is produced by the liver, then drained through the bile ducts and stored in the gallbladder between meals. Once food is consumed, the gallbladder empties the bile back into the bile ducts, after which point bile travels to the intestine to continue with the digestive process.
When any part of this complicated system becomes blocked or infected, biliary disease is the result. Biliary diseases include gallstones, cholecystitis, primary sclerosing cholangitis, and primary biliary cirrhosis. These diseases are common and costly, affecting 6.3 million men and 14.2 million women between ages 20 and 74. Biliary diseases, like pancreatic diseases, can bemalignant: biliary duct cancer (also known as cholangiocarcinoma)is known to be very difficult to treat successfully.
Some biliary and pancreatic diseases are congenital, meaning they are present in a patient since birth. Others are relatedto injuries, viruses, or alcohol abuse. In many cases, biliary andpancreatic diseases are severe and dangerous for the patient, andthey require immediate and expert medical care.

Symptoms and Diagnosis

Though pancreatic conditions sometimes produce no symptoms at all, they most commonly manifest in pain in the upper-middle part of the abdomen that travels to the mid-back. If diabetes or weight loss occurs simultaneously with onset of upper abdominal pain, pancreatic problems are the likely source.

Biliary diseases often produce abdominal pain in the upper right side, dark urine, fever, itching, jaundice, nausea, vomiting, or pale-colored stools.

There are a variety of procedures that physicians use to diagnose biliary and pancreatic diseases, including cholecystography (a procedure in which the patient swallows a contrast dye before a series of X-rays, allowing for the detection of gallstones and other abnormalities), CT scans, and endoscopic retrograde cholangiopancreatography (ERCP).

In ERCP, a thin, flexible instrument known as a duodenoscope is inserted through the mouth, down the esophagus and into the stomach and small intestine. After this, a contrast dye is injected through the duodenoscope, allowing the physician to take X-rays and sometimes even to remove the complication in the same procedure.

At Memorial Hermann, Dr. Attila Ertan brings his expertise as a recognized world leader in diagnostic and therapeutic ERCP. He has performed ERCP for over four decades, and is one of the best practitioners of this advanced procedure in the nation.

Treatment

Biliary and pancreatic diseases are both treated with similar techniques, including surgery and endoscopy. Depending on the specific type of disease, your physician may recommend:

  • Biliary or pancreatic sphincterotomy (a procedure that involves treating mucosal fissures from the anal canal)
  • Biliary or pancreatic stone removal
  • Biliary or pancreatic duct stenting (a procedure where a tube is inserted into a bile duct to treat obstructions and relieve the narrowing of the duct)
  • Biliary or pancreatic balloon dilations (a procedure that works in conjunction with other treatments for bile duct stones, making  stone removal safer and preserving the function of the biliary sphincter)