Internal View at Choledochoscopy

Golds In Gut

In the midst of global economic slump,bordering on recession if not depression, any glitter that resembles that precious metal asset Gold is very attractive indeed.

Unfortunately,that gold-like structures above is a picture of multiple bile duct stones being extracted endoscopically during a procedure called Endoscopic Retrograde Cholangio-Pancreatography, or in short ERCP.

These stones originated in the Gallbladder.

Patients with symptomatic Gallbladder Stones(=Gallstones) who delay treatment in the form of Laparoscopic Cholecystectomy may be complicated by Bile Duct stones.

Usually,patients will experience excruciating abdominal pain in the area of the Upper Right abdominal region associated with Jaundice(Yellow Eyes) and sometimes Fever.

The treatment consist of 2 steps;

1.ERCP to remove the Bile Duct stones

2.Laparoscopic Cholecystectomy to remove the diseased gallbladder containing the original stones

Endoscopic biliary stone extraction

Endoscopic biliary stone extraction is the standard way of removing a concomitant bile duct stones in patients suffering from gallstone disease prior to laparoscopic cholecystectomy.

The typical instrument used to catch,trap and remove the biliary stone is a Basket(pic.).

The usual size that ensure success is when the stone is less than 1cm...for a stone bigger than 1 cm,technically,its more difficult for the basket to negotiate the stone for trapping..

The usual stone type that is successfully removed is the soft,pigmented type with less cholesterol content....since the stone is softer and easily crushable

A modified basket called a Lithotriptor can crush a harder stone since it has a stronger force in the structure and design of the instrument

The profile of Gallbladder stones

This is a typical specimen of an inflamed gallbladder packed with pigmented cholesterol gallstones removed from a patient who has been suffering from typical Acute Cholecystitis.

The typical symptoms of Acute Cholecystitis are;

- acute upper abdominal pain after taking foods rich in fats

- nausea

- vomiting

- bloated abdomen after eating

- fever

- sharp pain with breathing

The inflamed gallbladder above was removed by Laparoscopic Cholecystectomy.

Laparoscopic Cholecystectomy is the Gold Standard for the treatment of any diseased gallbladder