's questions

[Guest guest]

Hi ,

Good for you for being proactive about Noah's care. He does need

regular monitoring. Especially if he already has some cirrhosis. As you

said. a liver biopsy only tells you about a small portion of the liver.

Cirrhosis in one area does not tell you the extent of cirrhosis and it

does not tell you whether the liver is compensating. You mentioned an

ERCP at Mayo. The ERCP report can provide a much more accurate picture

of Noah's biliary tree. If you don't have the ERCP report I am sure

you can get one from Mayo.

In Pittsburgh I asked Dr. Slivka if he recommended annual ERCPs to check

for bile duct cancer. He said no. He felt the risks of ERCP

(pancreatitis, infection etc.) are too high to justify annual ERCP. My

impression is that Slivka would do an ERCP only if there was a

therapeutic reason to do it.

My hepatologist feels the same way. He also opposes biopsies for annual

monitoring. His recommendation for regular monitoring is quarterly LFT

and cancer marker blood tests and an annual MRCP. He says that the

quality of MRCPs is improving so much that in some respects they give a

better picture of the entire biliary tree than an ERCP does. I

understand that Dr. Lindor at Mayo opposes biopsies and ERCPs for

routine monitoring. I believe Mayo patients get an ultrasound for

routine monitoring.

My hep also recommends colonoscopies that are more frequent than for

normal people depending on the severity of UC. My UC was severe and so

I got annual colonoscopies. It now responds to treatment and my next

colonoscopy is in three years.

I agree with my hep completely. Our livers and our bodies in general

are under a great deal of stress from PSC and UC. We need to treat

ourselves gently and so do our doctors. I prefer having non-invasive

monitoring and I will only agree to an ERCP, biopsy or other invasive

procedure if necessary therapeutically or to prepare for transplant.

, I hope you find this information useful. If Noah needs an ERCP,

I am sure Dr. Slivka is the best doctor to do it. He was very

impressive when he spoke in Pittsburgh.

(Sacramento) dx UC and PSC 2001