Clinically, 80% of gallstones don’t present with any symptoms or other problems, however, if the stone passes down into the common bile duct, it is potentially dangerous, (which is a possibility in 15% of the patients). Patients suffering from choledocholithiasis are at the risk of developing pancreatitis. The objective of the endoscopic surgery is to relive the blockage which is done using Endoscopic Retrograde Cholangiopancreatography (ERCP), which is a diagnostic test along with a procedure called ERS (Endoscopic retrograde sphincterotomy), which involves a surgical cut into the muscle in the common bile duct, to remove the stone. Bile duct surgery abroad provides a huge opportunity to save costs whilst ensuring same quality of surgical care and medical outcomes.
Endoscopic removal of bile stones in the Bile Duct
- Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic procedure for detecting problems in the bile ducts, liver, gallbladder and pancreas.
- The procedure involves the use of an endoscope in conjugation with X-rays. A flexible and long tube is inserted into the duodenum and a dye is injected into the biliary system, which is viewed on the X-ray.
- The procedure is conducted under the influence of local anesthesia, to numb the throat and allow swallowing of the endoscope, while sedation is given to allow the patient to relax during the procedure. The diagnostic procedure, along with the removal would take between half an hour to a couple of hours.
- Once the abnormality is detected, Endoscopic retrograde sphincterotomy is conducted to relive the obstruction and alleviate pain
- During sphincterotomy, surgical instruments are inserted to stretch the duct, which then allows easy access into the biliary duct system subsequently. After the duct is stretched, additional instruments are inserted to remove the stone or stretch the bile duct to relive symptoms of pain and obstruction.
- Occasionally, the stone is associated with inflammation which may cause a stricture (i.e. resulting in narrowing of the affected part of the bile duct). In such cases a stent is placed in the bile duct to maintain the patency of the duct. The stent may be a permanent or temporary stent. Temporary stents are used to maintain the patency more frequently in conjunction with ballooning dilation procedure (when an inflated balloon is used to stretch the stricture). However stents tend to clog the biliary system and may require a second procedure, to be removed or replaced after a few months.
Preparation for the endoscopic removal of stone in the bile duct
- It is essential to ensure that the intestinal tract is empty for the procedure and hence the patient is asked to avoid eating or drinking at least eight to twelve hours prior to the procedure
- Antibiotics are prescribed before the procedure, to ensure protection against any infection that could possibly occur after the procedure
- The patient is also expected to stop any medications like aspirin, NSAIDs (non steroidal anti-inflammatory drugs) or other blood thinning drugs a week prior to the scheduled date of the procedure, as these drugs tend to interfere with the ability of the blood to clot.
- For the diagnostic Endoscopic retrograde cholangiopancreatography (ERCP) procedure, the patient is made to lie on his left side. The patient is asked to swallow local anesthesia, so as to numb the throat and facilitate the swallowing of the endoscopic tube. Concurrently, sedation is also given to reduce anxiety.
Post operative Care after endoscopic removal of stone in the bile duct
- After the endoscopic removal, the patient is hospitalized for a day or two, as the physician would want to observe the patient for signs of complications
- Post operatively some amount of discomfort is common. Tenderness or sensation of a lump may be present for some hours after the surgery. Pain killers may be prescribed in case of too much pain and discomfort.
- Altering or changing the diet is not required after the removal of bile stones in the common bile duct. However clinical evidence is suggestive of the benefits of a fat free diet in reducing incidences of diarrhea and abdominal bloating. ” Though the patient is discharged within a couple of days, Physical exertion has to be avoided for a few weeks. It is best to return to routine work after a rest of couple of weeks.
Risks associated with endoscopic removal of bile stone from the common bile duct
Although complications are less frequent after the endoscopic surgery, overall complication rate ranges from 5-10%. The complications include,
- Over stretching of the bile duct which may result in a perforation or a hole
- Use of sedatives during the procedure may decrease cardiac and respiratory function, which however return to normalcy after the effect of the sedation wears off (i.e. within a few hours after the surgery)
- Other major complications associated with endoscopic surgery to remove bile stone includes, pancreatitis (which occurs in 2.3% of the patients), cholangitis (inflammation of bile ducts and occurs in less than 1% of the patients) or bacteremia, which may occur due to the passage of bacteria into the blood stream after the surgery.
- Hyperamylasemia (i.e. increase in levels of serum amylase) can occur in 8.3% of the cases
Management of gall stone in bile duct abroad saves considerable amount of expenses of the patients whilst ensuring same quality of medical care and medical outcome in comparison to the United States.
Endoscopic Bile stone removal surgery in India:
India has emerged as a centre for medical tourism thanks to its low cost gall stone surgery which allows cost savings of over 80% for American patients. Highly qualified medical teams and international standards of quality and medical protocols have resulting in the growth of the medical tourism market in the country. There are several JCI accredited hospitals in the country which provide quality medical care at low cost, compared to American Hospitals.
Endoscopic Bile stone removal surgery in Mexico:
Being close to the United States, health care in Mexico is rated as one of the best in the world. Mexican doctors are known for their international quality of medical care services in the United States. With additional advantages of cultural similarity and low cost of gall stone removal surgery abroad, Mexico is one of the most preferred medical tourism destinations.
Endoscopic Bile stone removal surgery in Turkey:
For almost a decade, Turkey has been providing low cost and good quality of medical care to international patients, especially from the Middle East. Turkey offers multiple treatment options to international patients and has several specialized healthcare institutions. As Turkey attempts to enter the league of the European Union, its medical care protocols are becoming increasingly stringent and at par with international standards.
Endoscopic Bile stone removal surgery in Jordan:
Jordan has been labeled as one of the most rapidly growing medical tourism destinations across the world. This is attributed to its superior quality of medical care, specialized and trained team of medical professionals, internationally accredited hospitals and latest and advanced technological equipments. Management of bile duct abroad, has the biggest advantage of cost savings for American patients
Endoscopic Bile stone removal surgery in South Korea:
A relatively newer destination in the medical tourism industry, South Korea, has focused extensively on upgrading its healthcare infrastructure, by using hi-tech equipments and technology. This Far East country offers significant cost savings for foreign patients, especially Americans, whilst maintain quality of care, at par with American standards.
Medical Tourism Corporation facilitates affordable Endoscopic Bile duct stone removal abroad at many international locations. Fill out the free estimate request form for a free quote & more information.