ERCP procedure or Endoscopic Retrograde Cholangio-Pancreatography is an assessment as well as a procedure meant for rectifying problems in bile and pancreatic ducts. This is considered to be a very critical and life saving procedure involving an endoscope. Examination of critical areas needs to be done and rectification has to be done immediately with planned procedural steps.
An ERCP procedure is recommended in order to diagnose the status of bile ducts and the pancreas and if there are problems discovered during diagnosis then they are treated as well. The procedure is appropriate in order to do evaluation of symptoms that are suggestive of certain diseases prevalent in these organs. It is also used as a method of reconfirmation of abnormal results generated from ultrasound, CT scan or imaging tests and blood tests. If CT scan reveals abnormal mass or stones in these organs then ERCP is recommended.
The procedure can even be performed before and after a gall bladder surgery to help in the conducted operation’s performance in overall. If there are stones or tumours of both cancerous and non cancerous nature then they can be removed with the help of ERCP procedure from bile ducts and pancreas. If there have been any complications noted during gall bladder surgery then those can also be diagnosed with the help of this. Patients having any pancreatic disease or suspected disorder for them the ERCP method can suggest the requirement of surgery and the type of surgery that may be best for the treatment. In some cases pancreatic stones can be addressed and removed with the help of ERCP procedure.
Causes of the problems are mainly because of narrowing or blockage of the bile ducts and pancreatic duct. Gall stones are formed and they get stuck to the common bile duct thus requiring surgical interventions. Gall stones are usually formed of cholesterol in maximum cases while for 20% cases it is a result of calcium and pigments like bilirubin giving rise to stones. Other causes can be imbalance of diet and irregular lifestyle giving rise to infection. Alcohol drinking and fatty food consumption results in acute and chronic pancreatitis.
The way to know that you may be a patient requiring ERCP is:
The procedure of ERCP enables the doctor or the surgeon to precisely examine the bile ducts and the pancreatic duct. In this procedure the endoscope which is a lighted tube and can be bent as well has a thickness of the index finger almost and it is inserted via the mouth of the patient and then it is made to access the stomach and the small intestine’s first part that is the duodenum. A small plastic tube named cannula is passed via the endoscope into the opening which is very small in size in the duodenum. The opening is called the ampulla. A contrasting substance or a dye is then injected and then X rays are carried out to start the study and find the status of the liver, pancreas and the ducts.
The surgery technique makes use of a combination of luminal endoscopy compiled with fluoroscopic technique of imaging for the purpose of diagnosing and performs treatment of conditions that are associated with pancreatobiliary system. A side viewing instrument named the duodenoscope is utilized in the endoscopic portion that is made to travel through the esophagus and reach the stomach to access the duodenum’s second portion which is the part of small intestine.
In ERCP Sphincterotomy both fluoroscope and endoscope are employed and deep cannulation is done of the bile duct which is then followed by the sphincter of Oddi’s severance with electrocautery (heating).
Coming back to conventional ERCP, next the duodenal pailla is identified with the scope in the position discussed above and further inspection is carried out to find any abnormalities. The duodenal papilla is like a structural protrusion of the ampulla of Vater or the hepatopancreatic ampulla into the duodenal lumen. The ventral pancreatic duct and the common bile duct have a convergence point and that is this ampulla. So this ampulla behaves like a channel for draining pancreatic secretions and bile into the duodenum.
If contrast is injected into the pancreatic duct or if the pancreatic duct gets cannulated for quite a number of times then a temporary pancreatic duct stent placement or rectally administered NSAIDS (diclofenac or indomethacin) has to be considered. This has to be considered aiming to reduce the post-ERCP pancreatitis (PEP) risks. For PEP prophylaxis these two prevention modalities have shown some promise. Somatostatin, gabexate, heparin, nitroglycerin, allopurinol, steroids, octreotide and many more pharmacological agents have been studied but the results found were pretty disheartening.
In the second portion or segment of the duodenum the minor duodenal papilla is also located and it behaves like an access point for the dorsal pancreatic duct. Dorsal pancreatic duct’s evaluation with ERCP is seldom performed and the ERCP indications are further discussed below:
With the side viewing endoscope the papilla is closely examined and then selective cannulation of ventral pancreatic duct or common bile duct is performed. Once the cannulation of the selected duct is performed then either pancreatogram of the pancreatic duct or cholngiogram of common bile duct is obtained fluoroscopically with the injection of a material that is radiopaque contrasting in nature is done into the duct. These days ERCP is considered by surgeons like a therapeutic surgery where abnormalities that are observed via a fluoroscope can be particularly addressed by the methods of specialized accessories that can be passed via the endoscope’s working channel.
This procedure is a very advanced process and as a result of this serious complications tend to occur at a higher frequency than many other endoscopic processes. As per that special training and specialized devices and equipments are employed and for appropriate indications only this procedure is employed.
Indications that have been recorded for biliary diseases are given below:
Assessment of biliary obstruction and its treatment secondary to choledocholithiasis- if ascending cholangitis, worsening pancreatitis or worsening jaundice which are persistent are present then Precholecystectomy ERCP may be indicated.
Pancreatic malignancies can be diagnosed and the indications are:
There are also indications for ampullary diseases like
If a patient has the possibilities of developing post ERCP pancreatitis, then the process of diagnosis grows apparent within some hours after the procedure. The patient shall experience severe pain in abdomen back pain and nauseated feelings may be accompanied with vomiting sensation) and some amount of fever is also common. But then the observation period does not stretch beyond an hour after the ERCP procedure and is not enough time for checking for post ERCP Pancreatitis. For evolving post ERCP pancreatitis a two hour serum or urinary amylase level (>1000IU/L) is highly predictive if the patient can be kept under observation for a longer duration of time.
Another kind of procedure closely related to ERCP is the employment of miniature endoscopes that can be inserted via the operating channel of the duodenoscope. These can be directly inserted into the pancreatic or the bile duct. The interior side of the duct can be visualized and accordingly biopsies can be taken. There remain other possibilities for therapeutic interventions.
If in the common bile duct the bile duct stones are seen then the opening of the papilla will be made wider with the help of electrocautery or heating and then the stones are removed. For removal of stones sometimes a basket may be employed. If the narrowing of the bile duct is seen in the X-ray images then a small wire mesh or plastic tube which is a stent can be inserted to facilitate the bypassing of the blockage and allow the bile to move to the duodenum. Very mild pain after ERCP stent placement is felt.
ERCP complication chances are vastly reduced when performed by expert surgeons but still there persists some amount of complications like:
If by accident food or fluid is inhaled in the lungs then that can be a complication but it rarely occurs in patients who do not drink and eat several hours prior before the ERCP test.
As the sedative medications start wearing off the patient will be observed for further complications. The medicines administered causes drowsiness and there are difficulties observed in concentration so a patient will be advised to stay away from work.
The discomfort as most patients have expressed is a feeling of bloating which is a result of the introduction of air in the system during the time of examination but this problems can be quickly fixed. Some patients experience a throat sore which is very mild usually.
Most patient are in a condition to drink clear liquid after the test and in some scenario blood tests have to be conducted right after the ERCP procedure. If biopsy samples have been taken then they are required to be sent to the lab for further analysis right after the procedure.
Some amount of fatigue is very common during the recovery period and for abnormal temperatures observed one should immediately inform the clinical team to check for the conditions.
ERCP (Diagnostic) package cost in Malaysia has different inclusions and exclusions. The cost quoted by some of the best hospitals for ERCP (Diagnostic) in Malaysia generally covers the pre-surgery investigations of the patient. The comprehensive ERCP (Diagnostic) package cost includes the cost of investigations, surgery, medicines and consumables. Post-surgical complications, new findings and delayed recovery may have an impact on the total ERCP (Diagnostic) cost in Malaysia.
There are many hospitals across the country that offer ERCP (Diagnostic) to international patients. The following are some of the most renowned hospitals for ERCP (Diagnostic) in Malaysia:
After ERCP (Diagnostic) in Malaysia, the patient is supposed to stay in guest house for another 3 days. This time frame is important to ensure that the surgery was successful and the patient is fit to fly back.
There are certain expenses additional to the ERCP (Diagnostic) cost that the patient may have to pay for. These are the chanrges for daily meals and hotel stay outside the hospital. These charges starts from USD 50 per person.
There are many cities that offer ERCP (Diagnostic) in Malaysia, including the following:
The patient has to spend about 1 day in the hospital after ERCP (Diagnostic) for proper recovery and to get clearance for discharge. During the recovery, the patient is carefully monitored and control tests are performed to see that everything is okay. If required, physiotherapy sessions are also planned during recovery in hospital.
There are more than 1 hospitals that offer ERCP (Diagnostic) in Malaysia. These hospitals have proper infrastructure for the treatment of patients who require kidney transplant. Apart from good services, the hospitals are known to follow all standard and legal guidelines as dictated by the local medical affairs body or organization.
Some of the leading hospital groups in Malaysia are:
These hospitals are more focused on providing quality treatment and are supported by the latest medical technologies and excellent infrastructure. With a two-tier healthcare system in Malaysia, the hospitals are highly advanced because of extensive support from the Malaysian government through investment in medical infrastructure. Malaysian Hospitals, with well-trained staff and excellent facilities, are on par with well-developed countries and have shown significant improvement in the last ten years.
The hospitals in Malaysia follow the healthcare standards set by Malaysian Society for Quality in Health (MSQH) and JCI. Presently, there are 12 JCI-accredited hospitals in Malaysia and all of them ensure that they meet global standards. MSQH has recently partnered with Malaysia’s Ministry of Health, Association of Private Hospitals Malaysia and the Malaysian Medical Association, to work together on raising the standards of healthcare in Malaysia. The process of receiving healthcare accreditation in Malaysia is very stringent and the hospitals are strictly evaluated on quality parameters.
An emerging global giant in medical tourism, Malaysia has one of the most strong healthcare systems in the world supported by solid governmental participation in the market and public-private healthcare collaboration. Malaysia has received worldwide recognition for its excellent healthcare system mainly attributed to advanced technology, modern infrastructure, and highly trained medical professionals. Malaysia is attracting a large number of medical tourists every year for cardiology and fertility treatments. Malaysia not only offers world-class, affordable treatment to medical tourists but also enhances their overall wellbeing through its food, cultural diversity, and heritage spots.
Malaysia has highly trained doctors and many of them are trained internationally before returning to work in their home country. Malaysia produces one of the finest doctors in the world because it has a strict evaluation process for offering degrees to them, and also the doctors need to serve in the public sector for at least 3 years, making them attain a high level of professionalism. Doctors in Malaysia are exceptionally good at handling IVF and cardiology cases and they have delivered excellent results in these two areas using their holistic treatment approach. Medical tourists can apply for eVisa for traveling to Malaysia to get medical treatment and reside there for a period of 30 days under the Malaysian Healthcare Travellers Program (MHTP).
Medical tourists can apply for eVisa for traveling to Malaysia to get medical treatment and reside there for a period of 30 days under the Malaysian Healthcare Travellers Program (MHTP). A person can get eVisa through online platforms and its validity expires in 3 months. A candidate would require below things to apply for an eVisa.
Medical Attendant Visa is granted to the person accompanying the patient to Malaysia and two persons are allowed to travel with the patient.
The most sought-after procedures available in Malaysia are prostate surgery, cosmetic surgery, dental work, vitiligo treatment, cancer care, discectomy. Cancer treatment through gene therapy is becoming popular in Malaysia as this novel technique guarantees reduced treatment costs, shorter treatment time, minimal adverse effects of current chemo-drugs. Hospitals and clinics in Malaysia are equipped with the latest technology to perform Assisted Reproductive Technique (ART) procedures such as In Vitro Fertilization (IVF), which has a marvelous success rate of 55 to 60. With recent advancements in orthopedic technologies, Malaysia offers some effective procedures such as hip replacement, shoulder replacement, knee replacement surgery.
Some of the leading medical tourism destinations in Malaysia are:
These cities have world-class hospitals with superior infrastructure and highly trained hospitals, all these contributing to an amazing patient experience. A large number of medical tourists visit Kuala Lumpur and Penang every year because of several reasons like the availability of reasonably-priced hotel rooms, better transportation systems, and connectivity through airlines. A large number of hospitals, scenic value, rich culture, availability of translators, and safety of tourists also contribute to the popularity of these cities in medical tourism.
A medical tourist traveling to Malaysia needs to get below vaccines:
Before a trip to Malaysia, you can get pre-exposure vaccination against rabies. Children are more vulnerable. Don’t forget to get Japanese encephalitis vaccination as is it common in Malaysia. Travellers arriving from countries with a risk of Yellow Fever may need an International Certificate of Vaccination.
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