Re: would appreciate some info

[Guest guest]

Hi,

I have never had an ERCP so I don't feel qualified to answer

most of your questions. I will say that the ERCP is an excellent

diagnostic tool, but does have a 15% chance of causing another

acute pancreatitis attack. This is why my doctor chose to do an

MRCP, which reveals just as much of the pancreas' status, yet is

totally non-invasive. One advantage of the ERCP is that if it's

determined that a stent needs to be placed to help with duct

obstruction, the procedure can be done while the specialist is

doing the ERCP.

I'm not sure of the percentage rates of diagnostic success with

this procedure, that is something that I could research through

my pancreatitis files that I've saved from internet searches, but it

would be a day or so before I could find this information. The

information may be available in Mark''s pancreatitis library at:

http://www.top5plus5.com/

You might check there.

Many of our members have had one or multiple ERCP's, so I am

sure that they will speak up and answer your specific questions

based on their own experiences.

Good luck with the procedure. Keep us posted.

With hope and prayers,

Heidi

Heidi H. Griffeth

South Carolina

SC & SE Regional Rep.

PAI, Intl.

Note: All comments or advice are personal opinion only, and

should not be substituted for professional medical consultation.

>>Need to see if anyone can give me some realistic

percentages type of info on those suffering acute pancreatitis.

> I am scheduled to have an ERCP done this Thursday (6th).

Have been reading some of posts on pancreatitis support sites,

and wondered if anyone could tell me anything about how

informative this test really ends up being. When it is done, is the

cause found most of the time for the acute pancreatitis attacks?

When it is done do they always do the one test I read about, I

think it had something to do with the Papilla? Do most people

actually end up being able to go home from the outpatient

procedure..or do most end up getting admitted?

[Guest guest]

Hi snowdogs:

I have had two ERCPs and am going in for another one this

Friday. The first ERCP ended up to be just a ERC (they didn't do

the pancreatogram, just the cholangiogram). This one did not

cause pancreatitis, but I had an overnight hospital stay because

they cut the sphincter of Oddi (any time a cut is done they tend to

keep you overnight). This was successful both diagnostically

and therapeutically - they did manometry and found a slightly

elevated sphincter pressure and then cut it. However, it didn't

successfully diagnose my pancreatic problem as they didn't do

the pancreatogram part of the ERCP. So I went in three weeks

later for an ERCP (this time with the " p " part) and endoscopic

ultrasound. This time the procedure was very successful in that

the doctor found the pancreatic duct obstruction and he was able

to place a stent to relieve the pressure. However, I did get a

slight case of pancreatitis. An overnight stay was required.

Friday's is suppose to be done as an outpatient procedure but

with the caution that it could (most likely) end up as an overnitght

stay.

So in my experience an ERCP is successful in diagnosing the

problem more often than not, especially if the whole test is run

and even more so, if it is combined with an endoscopic

ultrasound and / or manometry. As far as treatment - it is

successful, in that something can be done without major

disability and discomfort, but does it " cure " the problem? So far,

I still have the awful pain, but maybe stent number two and three

will offer relief of that.

Laurie

Oh, as far as discomfort: the first ERCP, in which the bile system

only was looked at and the sphincter of Oddi was cut, was a

" piece of cake " . No intense pain or discomfort, no lost days of

work due to recovery. However, the second one, when the

pancreas was looked at, the minor papilla cut and a stent placed

was pretty awful. Intense pain immediately after the procedure

and recovery was relatively long - longer than the recovery from

my laparoscopic gallbladder removal - and several days off from

work. I am hoping Friday's will be more like the first one!

[Guest guest]

Hi snowdogs:

I have had two ERCPs and am going in for another one this

Friday. The first ERCP ended up to be just a ERC (they didn't do

the pancreatogram, just the cholangiogram). This one did not

cause pancreatitis, but I had an overnight hospital stay because

they cut the sphincter of Oddi (any time a cut is done they tend to

keep you overnight). This was successful both diagnostically

and therapeutically - they did manometry and found a slightly

elevated sphincter pressure and then cut it. However, it didn't

successfully diagnose my pancreatic problem as they didn't do

the pancreatogram part of the ERCP. So I went in three weeks

later for an ERCP (this time with the " p " part) and endoscopic

ultrasound. This time the procedure was very successful in that

the doctor found the pancreatic duct obstruction and he was able

to place a stent to relieve the pressure. However, I did get a

slight case of pancreatitis. An overnight stay was required.

Friday's is suppose to be done as an outpatient procedure but

with the caution that it could (most likely) end up as an overnitght

stay.

So in my experience an ERCP is successful in diagnosing the

problem more often than not, especially if the whole test is run

and even more so, if it is combined with an endoscopic

ultrasound and / or manometry. As far as treatment - it is

successful, in that something can be done without major

disability and discomfort, but does it " cure " the problem? So far,

I still have the awful pain, but maybe stent number two and three

will offer relief of that.

Laurie

Oh, as far as discomfort: the first ERCP, in which the bile system

only was looked at and the sphincter of Oddi was cut, was a

" piece of cake " . No intense pain or discomfort, no lost days of

work due to recovery. However, the second one, when the

pancreas was looked at, the minor papilla cut and a stent placed

was pretty awful. Intense pain immediately after the procedure

and recovery was relatively long - longer than the recovery from

my laparoscopic gallbladder removal - and several days off from

work. I am hoping Friday's will be more like the first one!

[Guest guest]

Snowdog,

Your history sounds very much like my own except my recurrence

increased more quickly over time than yours has. I hope this is good

news for you -- that you will be able to have your pancreatitis

resolved with the least invasive methods available to you.

In October of 1999 I had some kind of attack but I cannot say for

sure it was pancreatitis as it may have been a gallstone crisis. I

woke up in the middle of the night in intense pain and throwing up

frequently. For some reason I endured it without going to the ER,

and saw my PCP after I was better (I wasn't going to leave the home

until I was no longer vomiting...silly me). The next attack was far

more intense and occurred in November of 1999. I was admitted for

gallstone pancreatitis. My GI at the time was very conservative and

advised me to not have my gallbladder removed unless I had another

occurrence. I did in Feb of 2000 and it was very bad. I fired that

GI, got a surgeon and had my gallbladder removed.

I continued to have discomfort following surgery so I had my first

ERCP. Nothing could be seen that was out of the ordinary and I did

not have any complications at all. The procedure was well done -- I

was partially sedated with demerol, and versid. I tolerated it well.

Unfortunately a couple of months later I had another attack of acute

pancreatitis which required a hospital stay. After I recovered from

that I underwent yet another ERCP, and this one was painful and

triggered another attack which required hospitalization. Again,

nothing unusual could be seen. None of the other tests showed any

reason for my attacks. The attacks continued. I had to work my way

through a few GIs to find someone who set me up with the GIs at the

Pancreatic Disease Center at the University of Cincinnati. I

underwent another ERCP with Sphincter of Oddi manometry which found

that I had Sphincter of Oddi dysfunction. During the ERCP I had a

sphincterotomy and a stent placed. For almost 9 months I was pain

and attack free.

Unfortunately starting in December of 2002 something went terribly

wrong and I began to have attacks every 3 weeks. Each required

hospitalization. I was evaluated by the surgeons of the Pancreatic

Disease Center and was told that in cases like mine, where the

attacks stem from no observable cause and are frequent that the best

option is a total pancreatectomy and islet cell transplant. May 15th

of this year I underwent this procedure. Though I became diabetic

and require insulin, my pain was resolved, and the attacks are gone.

I am able to resume a normal existence. It is a big surgery, and I

am still recovering and getting used to life as a diabetic but life

is good. Just got back from a very active and fun holiday in the

Great Smokies, so I cannot complain at all!

ERCPs are the gold standard for diagnosing causes of pancreatitis

but as in my case they are not always definitive. Because of the

risk of causing pancreatitis I think it is wise to first undergo an

MRCP which is an intensive MRI of the biliary tree and pancreas. An

MRCP doesn't hurt at all and has the same complications as a CAT

scan. It can rule out many problems and *might* prevent you from

having to undergo an ERCP. But if there are questions or concerns

after an MRCP than an ERCP will be the next test ordered.

Sorry I wrote so much. Just feel free to keep asking questions and

we will all do our best to help.

Thanks and good luck,

Bert