ERCP (Diagnostic) in Thailand

Treatment and Cost

0

Total Days
In Country

2 No. Travelers

0 Day in Hospital

0 Days Outside Hospital

Treatment Price not available

Get a Quote

Hospitals

About the ERCP (Diagnostic)

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.

Who needs an ERCP?

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 ERCP

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.

Symptoms of ERCP

The way to know that you may be a patient requiring ERCP is:

  • Abdominal cramps
  • Fever and Nausea
  • Vomiting tendency with occasional bleeding
  • Irritation felt in the stomach
  • General fatigue experienced

 

What is ERCP?

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.

How is ERCP (Diagnostic) performed?

ERCP surgery

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.

  • With intraoperative cholnagiography or common bile duct exploration without the extraction of stone, treatment of choledocholithiasis is identified during cholcystectomy.
  • Bile duct stricture assessment and subsequent treatment- bening and malignat strictures and and congenital abnormalities of the bile duct.
  • Postoperative complications
  • Postoperative biliary leaks’ treatment and assessment
  • Sphincter of Oddi dysfunction of selected patients, their assessment with treatment with little benefit in modified Milwaukee classification type III patients
  • For recurrent and acute pancreatitis for which the underlying cause is unknown in patients; their treatment followed after assessment
  • Symptomatic strictures associated with chronic pancreatitis; assessment and treatment
  • Symptomatic pancreatic duct stones; their treatment after assessment
  • Symptomatic duct stones’ assessment and treatment

Pancreatic malignancies can be diagnosed and the indications are:

  • Biopsy and brushing of the bile duct
  • Pancreatoscopy
  • Intraductal ultrasonography

There are also indications for ampullary diseases like

  • Assessment of ampullary malignancy
  • Ampullary adenomas’ assessment and treatment

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 Complications

ERCP complication chances are vastly reduced when performed by expert surgeons but still there persists some amount of complications like:

  • Pancreatitis or inflammation of the pancreas is the commonly occurring complication found in 3 to 5% of the patients undergoing the surgery. Usually it is mild causing nausea and pain in the abdomen region which can be treated during the stay in hospital. It is very rare that pancreatitis grows severe during ERCP.
  • A cut into the ampulla becomes necessary by the endoscopist and as soon as that happen some amount of bleeding can occur at the site of the cut ampulla. However it is minimal and stops in sometime all by itself or it can be controlled during the surgery.
  • A tear or hole in the intestine can happen accidentally due to the insertion of the scope or any other instrument. This happens rarely but when it occurs it is a serious condition requiring immediate surgical intervention.
  • Infection or cholangitis is also very rare in the bile ducts but if it occurs among patients with preexisting conditions then treatment has to be started where antibiotics need to be administered and drainage of excess fluids need to be carried out.


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.

Recovery from ERCP (Diagnostic)

Aftercare and recovery

 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.

Patient Stories

Frequently Asked Questions

What is the health care infrastructure of Thailand / Why should opt for Thailand as a destination for your medical treatment
Hospitals in Thailand have seen an increase in number in the past few years. One of the many reasons for such surprise growth in the healthcare division can be the development of the public health sector which comprises 9,765 health locations along with 1,002 hospitals. As the Public Hospitals in Thailand are operated by the MOPH (Ministry of Public Health), the Private Hospitals in Thailand are regulated under the Medical Registration Division. The treatments in Thailand are also keeping up with that of other major countries all across the globe. As of 2002, the Thai Government has provided a countrywide general healthcare system that covers 99.5% of the Thai population and ensures high-quality treatments in Thailand and affordable primary medical amenities to each and every citizen of Thailand. In the year 2009, the total national expenditure on healthcare was 4.3% of the GDP of Thailand. Due to such medical advancements in Thailand, the country has become the most preferred medical destination in the world providing wide-ranging medical treatments at highly-reasonable rates at good hospitals in Thailand.
What are the conditions of the hospitals in Thailand? Are they JCI certified? What is the quality of the support staff in the hospitals?
The Joint Commission International (JCI) is a global leader in health care accreditation. JCI accreditation is considered a gold standard in worldwide health care. It provides the most skilled and experienced healthcare professionals in the medical industry, as evaluators of the rigorous international standards in healthcare quality and patient safety. Here are a few JCI certified hospitals in Thailand :
  • Yanhee Hospital
  • Bumrungrad Hospital
  • Bangkok Hospital
  • Chaophya Hospital
  • BNH Hospital
  • Ramkhamhaeng Hospital
  • Vejthani Hospital
  • Bangkok Hospital Phuket
  • Samitivej Sukhumvit Hospital
  • Praram 9 Hospital
  • Chiangmai Ram Hospital
  • Sikarin Hospital
  • Synphaet Hospital
  • Bangkok Hospital Samui
  • Nonthavej Hospital
  • Bangkok Hospital Pattaya
  • Samitivej Srinakarin Hospital
  • Samitivej Sriracha Hospital
Are the doctors/surgeons in Thailand of the best quality?
Thailand is gaining recognition for the quality of its healthcare services after the US magazine CEOWORLD placed Thailand 6th in its 2019 list of countries with the best healthcare systems. Thai doctors gain a lot of skills during their course and this helps them practice effectively. Many doctors and surgeons also visit other countries for training and certification courses to enhance their skills and knowledge. Most doctors are exposed to a public and private healthcare system in order to be able to work in any condition. It is a collective effort from all the professionals to maintain the standard of health and Thailand is doing just that.
What is the process for obtaining a medical visa in Thailand?
Currently, medical tourists To Thailand are allowed in from 34 countries. All visitors must have proof of travel health insurance that covers a minimum of US$100,000 of medical costs incurred in Thailand, including medical costs in the event that they contract COVID-19. Under the CCSA regulations, medical tourists have to arrive by air to ensure effective disease control, not via land border checkpoints. All must have an appointment letter from a doctor in Thailand and entry certificates issued by Thai embassies across the globe. People wanting to visit Thailand for medical procedures need to contact the Thai Embassy in their country to organize the visa and paperwork. Thailand’s major hospitals will provide potential candidates with an appointment letter. Permission for medical tourists to be accompanied by up to three attending persons is intended to allow such patients to have spouses, parents, or assistants in attendance during their treatment in Thailand. However, such persons will have to conform to all the same entry requirements as the medical tourists themselves, including visas and health status.
What support services does MediGence provide in Thailand?
MediGence enables you to plan and manage your medical decisions better. These are some of our services offered:
  • Expert Opinion
    We help you seek an Expert Opinion on your diagnosis and treatment from an experienced team of doctors at MediGence and specialists from a reputable hospital.
  • Hospital Recommendation
    We recommend a hospital or a healthcare institution that is best suited for you, based on your ailment and its criticality.
  • 360-degree Hospital Review
    We give you a transparent and holistic view of the hospital and its infrastructure, accreditation, facilities, and expertise to give you confidence.
  • Doctor Validation and Communication
    We share a comprehensive profile of the treating doctor and also arrange a call to clear queries regarding treatment if needed.
  • Options to Choose From
    Based on your choice of destination and other preferences, we provide you multiple options with respect to hospitals and doctors to choose from.
  • 24X7 Patient Care Support
    A dedicated patient case manager stays in constant touch with you to help you at every step of the decision-making process and resolve queries that you may have.
  • Transparent Treatment Cost and Other Expenses
    We give a clear and accurate indication of the total cost of treatment including treatment, stay, meals, and other expenses.
  • Visa Assistance
    We provide and help prepare documentation for visa approval and coordinate with the embassy to expedite the visa process.
  • Accommodation Arrangements
    We propose to you a choice of accommodation based on your preference such as long stay, short stay, or luxury properties.
Which are the best cities in Thailand for medical treatment?
Bangkok is the capital of Thailand and the most sought - after destination for healthcare. It has more than 10 of the major hospitals in Thailand. The cost of treatment in Thailand is reasonable here. People tend to spend their recovery time in Bangkok as well as it is a beautiful city to visit as a tourist.

Our team of healthcare experts would be happy to assist you

Get In Touch
or call

(+1) 424 283 4838