Endoscopy and Percutaneous Drainage
Endoscopy is the procedure in which a special flexible camera (scope) is introduced into the stomach for diagnostic or therapeutic purposes. It can look inside the stomach and duodenum to diagnose cancer or benign ulcer. There are two special types of endoscopy which are frequently used in surgery of the liver, pancreas and bile ducts. These two special types of endoscopy are endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography.
Endoscopic Ultrasound (EUS)
Endoscopic ultrasound is a special form of endoscopy. It uses a special scope, which has an ultrasound probe built into its tip. That allows to perform an ultrasound study through the wall of the stomach or duodenum. This special ultrasound is used to evaluate usually the pancreas or the bile duct or the lymph nodes around them. It is able to see if the cancer has grown into the big blood vessels around the pancreas. It is also able to obtain a biopsy and that is the preferred and considered best way of obtaining a biopsy from the pancreas.
Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
ERCP is another special form of endoscopy. It uses a separate channel through which it can pass wires and catheters into the bile duct and pancreatic duct. Thus, it can obtain a special contrast X-Ray of the bile duct and pancreatic duct which can show the site of bile leak or blockage of the bile duct from stones or tumor. It can also remove stones from the bile duct. It can also place a bile duct stent to stop a leak or to relieve blockage from cancer.
Percutaneous drainage
Sometimes there is a cancer blocking the bile duct. We would first try to relieve the blockage by placing an endoscopic stent through ERCP (see above). However, sometimes it is not possible to deploy successfully an endoscopic stent. In these cases, a drainage catheter is placed through the skin, through the liver inside the bile ducts in the liver. This is called percutaneous transhepatic cholangiogram (PTC). It is possible to place a stent through the percutaneous drain. A variant of percutaneous drainage is percutaneous cholecystostomy tube placement. It is used to drain the gallbladder when it is too inflamed to operate on it or if it is otherwise unsafe to operate on it. Later, 6 weeks or longer after the tube placement, the gallbladder can be removed surgically safely.