Liver, Gallbladder & Bile Duct Diseases

We perform advanced endoscopic procedures like diagnostic and therapeutic Endoscopic-ultrasound (EUS) and Endoscopic retrograde cholangiopancreatography (ERCP) for the diseases pertaining to the liver, gallbladder, and bile ducts. EUS is a thin flexible tube attached with a camera and ultrasound probe at its tip which uses sound waves to produce images of an area of interest in gastrointestinal tract.  It is passed through the mouth and advanced into esophagus (food pipe), stomach and small intestine. Endoscopic retrograde cholangiopancreatography (ERCP) is also a flexible tube attached with a camera at its tip. It is passed through mouth and advanced up to the opening of the bile duct and pancreatic duct. ERCP is performed in conjunction with X-rays.

Procedures performed:

  • EUS guided Liver biopsy
  • EUS guided Variceal embolization.
  • ERCP for bile duct stricture, Bile duct stones
  • ERCP/Radiofrequency ablation for Malignant bile duct strictures
  • ERCP/Ampullectomy
  • ERCP/Spyglass Cholangioscopy

Liver Diseases:

Liver is the largest organ in our body.  Its main function is to purify blood from toxins and provide other metabolic functions. There are many acute and chronic liver diseases including but not limited to Viral infections like Hepatitis B, Hepatitis C, Alcoholic liver disease, Fatty liver disease, primary biliary cirrhosis, Inherited conditions etc. While most of the liver diseases are adequately managed by our dedicated Transplant hepatology team, some of these liver problems can cause blockage of the drainage tubes of the liver which might need advanced procedure like ERCP (Endoscopic retrograde cholangiopancreatography) to relieve the blockage and place a temporary stent (drainage tube).

Advanced liver disease can sometimes form varices (enlarged veins) in and around the esophagus (food pipe) or stomach. These varices can potentially rupture and cause life threating bleeding. There are various options to prevent these varices from rupturing like placing rubber bands, injecting a sclerosant etc. In addition, we can use Endoscopic ultrasound guidance and place coils and glue into these varices and prevent from rupturing (also called EUS guided variceal embolization).

Some of the liver diseases require a liver biopsy (taking a sample of liver tissue to examine under microscope) and we can perform Liver biopsy under endoscopic Ultrasound guidance.

We work very closely with our dedicated team of Liver transplant surgeons, Hepatologists and manage some of the pre-transplant or post-transplant issues that require our advanced procedural expertise.

Gallbladder Diseases:

Gallbladder is pear shaped organ located on right upper side of your abdomen just underneath the liver. It is well known as a reservoir of Bile juice produced by liver. It contracts and empties bile into the small intestine with meals and helps in the digestion of the ingested food. Stones ranging from size of grain to golf ball can form in the gall bladder due to bile stasis, hormonal changes, fatty food intake, obesity etc. Stones can sometimes obstruct the opening of the gall bladder and can lead to acute cholecystitis (infection/inflammation of the gall bladder) which can be surgical emergency. Such patients ideally need Gall bladder surgery (Cholecystectomy) to take the gall bladder out. Sometimes surgery cannot be performed due to poor surgical candidacy and in such cases our team can use EUS guidance to drain the gall bladder by connecting the gall bladder to small intestine using a stent/drain.

Bile Duct Diseases:

Bile ducts are drainage tubes of the liver in connection with the gall bladder. Bile produced by liver flows through the smaller bile ducts into the gall bladder and from the gall bladder into the small intestine through larger bile ducts also called common bile duct/common hepatic duct.

There are various problems that can develop within the smaller and large bile ducts. Stones from gall bladder can migrate to the bile duct leading to abdominal pain, jaundice, infection (choledocholithiasis). Cancer arising from liver, gallbladder, bile duct, pancreas can block the bile ducts forming a stricture (narrowing) of the bile duct leading to inadequate bile drainage.  Injury to the bile ducts because of motor vehicle accidents/trauma/complication of surgery can lead to Bile leak (leakage of bile juice outside of the bile ducts into the abdominal cavity and leading to infection). Other conditions affecting bile ducts are cysts (choledochal cysts), anatomic variants, congenital anomalies etc.

Most of above problems are treated with minimally invasive procedure like ERCP during which obstructing stones can be removed and bile drainage can be accomplished by placing a temporary stent/drain across the bile duct stricture. There has been tremendous development in the tools and techniques we use for managing bile duct problems. One of the revolutionary devices is a spyglass cholangioscope (thin flexible tube connected with a camera at the end) which can be advanced deep inside the bile ducts not only to diagnose the problem accurately but also to treat appropriately.

We work closely with our Surgical Oncology and Medical Oncology colleagues and help them in providing timely diagnosis of bile duct cancer. In some selected cases, we can perform Ablation (technique using controlled current) of bile duct stricture to destroy cancerous tissue and limiting progression of cancer.

Bile duct joins pancreatic duct and opens into an area in the small intestine called ampulla of vater. Ampullary cancer can arise from this area which needs a major surgery in most cases. However, in some selected cases, we perform Ampullectomy (removing the cancerous ampullary tissue by endoscopy).