RE: Is ERCP the only way to remove bile duct sludge ?

[Guest guest]

Bile duct " sludge " is indeed a common problem, and is best treated

(noninvasively) with Urso and hydration. Before I was diagnosed, I would get

URQ (upper right quadrant) pain when dehydrated - like after a run. Several

glasses of water would eventually fix it. This lasted for a couple of years

until the stricture got too narrow.

I know of no other way to dilate a stricture other than through ERCP. With the

symptoms he's got, I personally also wouldn't wait, but I WOULD try to find a

Dr. that does it for a living, more frequently than once month or so. My first

ERCP was done by someone like that - he was unable to even get the instrument in

there to dilate it. One year later, it was done at Mayo with no problems. The

endoscopist at Mayo did about a dozen that day alone.

Hope that helps.

Arne

============================================================

apart from strictures, MRCP also deducted a fair bit of sludge in the bile duct

and thinks that the sludge is presently the dominant reason for obstruction.

Asked the doc if we can try dissolving the sludge, but he seemed very very eager

to do an ERCP. Simply didn't discuss any other option.

Shouldn't we be waiting for the stricture to get more dominant before ERCP and

just remove the sludge ? Is there any other way to remove that? Not happy with

our doc. Need to find another, anyone know of any

great ones in sydney ?

============================================================

[Guest guest]

Bile duct " sludge " is indeed a common problem, and is best treated

(noninvasively) with Urso and hydration. Before I was diagnosed, I would get

URQ (upper right quadrant) pain when dehydrated - like after a run. Several

glasses of water would eventually fix it. This lasted for a couple of years

until the stricture got too narrow.

I know of no other way to dilate a stricture other than through ERCP. With the

symptoms he's got, I personally also wouldn't wait, but I WOULD try to find a

Dr. that does it for a living, more frequently than once month or so. My first

ERCP was done by someone like that - he was unable to even get the instrument in

there to dilate it. One year later, it was done at Mayo with no problems. The

endoscopist at Mayo did about a dozen that day alone.

Hope that helps.

Arne

============================================================

apart from strictures, MRCP also deducted a fair bit of sludge in the bile duct

and thinks that the sludge is presently the dominant reason for obstruction.

Asked the doc if we can try dissolving the sludge, but he seemed very very eager

to do an ERCP. Simply didn't discuss any other option.

Shouldn't we be waiting for the stricture to get more dominant before ERCP and

just remove the sludge ? Is there any other way to remove that? Not happy with

our doc. Need to find another, anyone know of any

great ones in sydney ?

============================================================

[Guest guest]

Bile duct " sludge " is indeed a common problem, and is best treated

(noninvasively) with Urso and hydration. Before I was diagnosed, I would get

URQ (upper right quadrant) pain when dehydrated - like after a run. Several

glasses of water would eventually fix it. This lasted for a couple of years

until the stricture got too narrow.

I know of no other way to dilate a stricture other than through ERCP. With the

symptoms he's got, I personally also wouldn't wait, but I WOULD try to find a

Dr. that does it for a living, more frequently than once month or so. My first

ERCP was done by someone like that - he was unable to even get the instrument in

there to dilate it. One year later, it was done at Mayo with no problems. The

endoscopist at Mayo did about a dozen that day alone.

Hope that helps.

Arne

============================================================

apart from strictures, MRCP also deducted a fair bit of sludge in the bile duct

and thinks that the sludge is presently the dominant reason for obstruction.

Asked the doc if we can try dissolving the sludge, but he seemed very very eager

to do an ERCP. Simply didn't discuss any other option.

Shouldn't we be waiting for the stricture to get more dominant before ERCP and

just remove the sludge ? Is there any other way to remove that? Not happy with

our doc. Need to find another, anyone know of any

great ones in sydney ?

============================================================

[Guest guest]

I think your doctor is right in this case. I had the exact same problem with my gallbladder passing sludge to the bile ducts and clogging them at the strictures. In the ERCP after I started to be symptomatic they performed a sphincterectomy (which I understand now should be avoided if possible, but they had problems to access my bile ducts), they had to stop the ERCP after the sphincterectomy because they couldn't see anything anymore because of the sludge. In the ERCP second a few weeks later they removed the sludge as much as possible, opened strictures and placed a stent. A few weeks later they performed a cholecystectomy (removal of gall bladder) to take away the source of the sludge, to be followed two months later by another ERCP to clean up any remaining sludge and to remove the stent. Right now my bloodtests are normal, I am taking UDCA 30mg/kg and vitamins ADEK. This of course is no guarantee whatsoever that it will be the same with your husband but I am just telling you what happened to me. If you find yourself a good doctor that knows how to handle the ERCP there should be no problem and it should be safe.

-----Original Message-----From: [mailto: ]On Behalf Of prichsySent: Wednesday, October 18, 2006 1:21 PMTo: Subject: Is ERCP the only way to remove bile duct sludge ?

apart from strictures, MRCP also deducted a fair bit of sludge in the bile duct and thinks that the sludge is presently the dominant reason for obstruction. Asked the doc if we can try dissolving the sludge, but he seemed very very eager to do an ERCP. Simply didn't discuss any other option. Shouldn't we be waiting for the stricture to get more dominant before ERCP and just remove the sludge ? Is there any other way to remove that? Not happy with our doc. Need to find another, anyone know of any great ones in sydney ?

[Guest guest]

> Shouldn't we be waiting for the stricture to get more dominant before

> ERCP and just remove the sludge ?

My endoscopist explained to me that the more blocked the duct is, the higher the

chances

of developing infection following ERCP. The bile flow would not be sufficient to

wash out

whatever is in the duct.

There is a point of no return in terms of the narrrowness of a stricture. They

need to be

able to pass a guide wire thru the stricture in order to get the balloon up

there, inflate it to

open the duct, and place a stent. If they can't pass a guide wire, they could

perforate the

duct, so they don't do it blind.

If it were me, I'd want to do the ERCP right away. It has the potential to

relieve his

symptoms, which are already pretty difficult to deal with, aren't they? I don't

think you will

gain anything by waiting. The only other thing they would be able to do is a

PTC, which

would involve placing tubes in the intrahepatic bile ducts above the strictures

and draining

bile to bags on the outside of his ribcage. I had a PTC but it failed, and had

complications.

There's an infection risk from that too, though no risk of pancreatitis. The PTC

was meant

to be a prelude to a biliary bypass, which is a major surgery, and most people

aren't

suitable for it because of where the stricture is.

Martha (MA)

[Guest guest]

> Shouldn't we be waiting for the stricture to get more dominant before

> ERCP and just remove the sludge ?

My endoscopist explained to me that the more blocked the duct is, the higher the

chances

of developing infection following ERCP. The bile flow would not be sufficient to

wash out

whatever is in the duct.

There is a point of no return in terms of the narrrowness of a stricture. They

need to be

able to pass a guide wire thru the stricture in order to get the balloon up

there, inflate it to

open the duct, and place a stent. If they can't pass a guide wire, they could

perforate the

duct, so they don't do it blind.

If it were me, I'd want to do the ERCP right away. It has the potential to

relieve his

symptoms, which are already pretty difficult to deal with, aren't they? I don't

think you will

gain anything by waiting. The only other thing they would be able to do is a

PTC, which

would involve placing tubes in the intrahepatic bile ducts above the strictures

and draining

bile to bags on the outside of his ribcage. I had a PTC but it failed, and had

complications.

There's an infection risk from that too, though no risk of pancreatitis. The PTC

was meant

to be a prelude to a biliary bypass, which is a major surgery, and most people

aren't

suitable for it because of where the stricture is.

Martha (MA)

[Guest guest]

> Shouldn't we be waiting for the stricture to get more dominant before

> ERCP and just remove the sludge ?

My endoscopist explained to me that the more blocked the duct is, the higher the

chances

of developing infection following ERCP. The bile flow would not be sufficient to

wash out

whatever is in the duct.

There is a point of no return in terms of the narrrowness of a stricture. They

need to be

able to pass a guide wire thru the stricture in order to get the balloon up

there, inflate it to

open the duct, and place a stent. If they can't pass a guide wire, they could

perforate the

duct, so they don't do it blind.

If it were me, I'd want to do the ERCP right away. It has the potential to

relieve his

symptoms, which are already pretty difficult to deal with, aren't they? I don't

think you will

gain anything by waiting. The only other thing they would be able to do is a

PTC, which

would involve placing tubes in the intrahepatic bile ducts above the strictures

and draining

bile to bags on the outside of his ribcage. I had a PTC but it failed, and had

complications.

There's an infection risk from that too, though no risk of pancreatitis. The PTC

was meant

to be a prelude to a biliary bypass, which is a major surgery, and most people

aren't

suitable for it because of where the stricture is.

Martha (MA)

[Guest guest]

Hi prichsy

Need to find another, anyone know of any

> great ones in sydney ?

>

If there is not a Sydney in American, can I then deduce you are next

door in Australia?

in the south of New Zealand

[Guest guest]

Hi prichsy

Need to find another, anyone know of any

> great ones in sydney ?

>

If there is not a Sydney in American, can I then deduce you are next

door in Australia?

in the south of New Zealand

[Guest guest]

Hi prichsy

Need to find another, anyone know of any

> great ones in sydney ?

>

If there is not a Sydney in American, can I then deduce you are next

door in Australia?

in the south of New Zealand

[Guest guest]

Hi ,

Abso right. Infact we have just moved to OZ from NZ and are Kiwis

alright.Moved 3 months ago after hubby accepted a greaty job-offer and

this whole episode, symptoms and diagnosis have just happened. In NZ,

just very mild colitis.

Which part of NZ are you from ? We're basically from Auckland. I times

like these, you simply want to give everything up and come back home.

>

> Hi prichsy

> Need to find another, anyone know of any

> > great ones in sydney ?

> >

>

> If there is not a Sydney in American, can I then deduce you are next

> door in Australia?

> in the south of New Zealand

>

[Guest guest]

Infact we have just moved to OZ from NZ and are Kiwis

> alright.Moved 3 months ago after hubby accepted a greaty job-offer

Hi again

I have contact with Alison Butcher and she has let me know:

Hi

Yes Dr Warwick Selby at RPA Newtown is a Professor and specialist in

this

field. I see him and travel from Newcastle regularly to see him. I

would

recommend him. If you would like to know more then just contact me.

Alison

her email is

butchersakne@...

My email is

grahammilligan@...

if you wish to contact me directly.

Best wishes

[Guest guest]

Infact we have just moved to OZ from NZ and are Kiwis

> alright.Moved 3 months ago after hubby accepted a greaty job-offer

Hi again

I have contact with Alison Butcher and she has let me know:

Hi

Yes Dr Warwick Selby at RPA Newtown is a Professor and specialist in

this

field. I see him and travel from Newcastle regularly to see him. I

would

recommend him. If you would like to know more then just contact me.

Alison

her email is

butchersakne@...

My email is

grahammilligan@...

if you wish to contact me directly.

Best wishes

[Guest guest]

Infact we have just moved to OZ from NZ and are Kiwis

> alright.Moved 3 months ago after hubby accepted a greaty job-offer

Hi again

I have contact with Alison Butcher and she has let me know:

Hi

Yes Dr Warwick Selby at RPA Newtown is a Professor and specialist in

this

field. I see him and travel from Newcastle regularly to see him. I

would

recommend him. If you would like to know more then just contact me.

Alison

her email is

butchersakne@...

My email is

grahammilligan@...

if you wish to contact me directly.

Best wishes