ERCP (Diagnostic) cost in Thailand

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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 are the factors affecting the cost of ERCP (Diagnostic) in Thailand?

ERCP (Diagnostic) cost in Thailand varies from one hospital to the other. The top hospitals for ERCP (Diagnostic) in Thailand covers all the expenses related to the pre-surgery investigations of the candidate. Typically, the package cost of ERCP (Diagnostic) in Thailand includes the expenses related to the surgeon's fee, anesthesia, hospital, meals, nursing and ICU stay. Post-surgical complications, new findings and delayed recovery may have an impact on the total ERCP (Diagnostic) cost in Thailand.

Which are some of the best clinics in Thailand for ERCP (Diagnostic)t?

There are many hospitals across the country that offer ERCP (Diagnostic) to international patients. Some of the most renowned hospitals for ERCP (Diagnostic) in Thailand include the following:

  1. MALI Interdisciplinary Hospital
  2. Bangpakok 9 International Hospital (BPK 9)
How many days does it take to recover post ERCP (Diagnostic) in Thailand?

Upon discharge from the hospital after ERCP (Diagnostic) in Thailand, the patients are advised to stay for about 3 days for recovery. During this time, the patient undergoes medical tests and consultations. this is to ensure that the treatment was successful and the patient us safe to return.

Which are some of the other popular destinations for ERCP (Diagnostic)?

Thailand is undoubtedly one of the best countries for ERCP (Diagnostic) in the world. It offers the best medical expertise and good patient experience at an affordable cost. However, there are other countries as mentioned below that are popular for ERCP (Diagnostic) as well:

CountryCost
IndiaUSD 800
SingaporeUSD 14000
TurkeyUSD 4500
How much are the other expenses in Thailand apart from the cost of ERCP (Diagnostic)?

Apart from the ERCP (Diagnostic) cost, there are a few other daily charges that the patient may have to pay. These are the charges for daily meals and accommodation outside the hospital. The extra charges may start from USD 50 per person.

Which are the best cities in Thailand for ERCP (Diagnostic) Procedure?

Some of the cpopular cities in Thailand that offer ERCP (Diagnostic) include the following:

  1. Bangkok
  2. Krabi
How many days does one have to spend in the hospital for ERCP (Diagnostic) in Thailand?

The average duration of stay at the hospital after ERCP (Diagnostic) is about 1 day for proper care and monitoring. The doctors team review the patient's recovery during this time with the help of blood tests and imaging scans. Once they feel that everything is on track, the patient is discharged.

How many hospitals offer ERCP (Diagnostic) in Thailand?

There are more than 2 hospitals that offer ERCP (Diagnostic) in Thailand. The above listed clinics are approved to perform the surgery and have proper infrastructure to handle ERCP (Diagnostic) patients. Such hospitals follow all legal protocols and guidelines as specified by the local medical affairs body when it comes to the treatment of international patients.

Who are the best doctors for ERCP (Diagnostic) in Thailand?

FAQ's Related to Thailand

What healthcare accreditation standards are followed in Thailand?

The Thai healthcare system has abundance of resources, from technological, human resources and financial resources. Thailand has a combination of a strong public healthcare system and private healthcare system which work together make a solid foundation. The Institute of Hospital Quality Improvement and Accreditation (HQIA) awards Thai HA accreditation on the basis of standard and quality of healthcare in Thailand. Not only these criteria but even the service delivery levels are maintained through the Institute of Hospital Quality Improvement and Accreditation.

Which are the popular multispecialty hospital groups in Thailand?

The Thai healthcare system is based on the personal touch they provide to their patients and the adherence to providing excellent clinical care. The option of having several specialties at one place makes it easy for any medical traveller to compare and explore their treatment options within several hospitals. The globally recognised specialists provide the best treatment to patients and this makes them reliable. There are several high performing multispecialty hospitals in Thailand such as :

  1. Bangkok Dusit Medical Services (BDMS),
  2. Bumrungrad International Hospital, Bangkok,
  3. Vejthani Hospital, Bangkok,
  4. BNH Hospital, Bangkok,
  5. Yanhee Hospital, Bangkok,
  6. Sikarin International Hospital, Bangkok,
  7. Princ Hospital Suvarnabhumi, Bangkok,
  8. Samitivej Sukhumvit Hospital, Bangkok,
  9. Bangkok International Hospital, Bangkok,
  10. The Bangkok Christian Hospital, Bangkok,
  11. Phyathai Hospitals, Bangkok,
  12. Saint Louis Hospital, Bangkok and,
  13. Central General Hospital, Bangkok.
Why should I opt for healthcare in Thailand?

Thailand has long been synonymous as being a popular health tourism destination. International patient services add value to your treatment experience in Thailand. You will get Interpreters, International medical coordinators, concierge services, embassy and airport transfer assistance and International insurance coordination in one place. All treatment options from plastic surgeries to tertiary care procedures are found in Thailand hospitals.

What is the quality of doctors in Thailand?

Doctors in Thailand are on par with best surgeons across the world in terms of the skill and expertise. The doctors are well versed in their field of expertise and their skiils are vouched for by various experts. Whether it is providing quality care or investing in innovative techniques doctors in Thailand are doing it all. They work with a host of international patients who have found solace and comfort.

When traveling to Thailand for medical treatment, what essential documents do I need to carry along?

The decision to come to Thailand should be done in tandem with getting the documents ready. Travel documents, medical documents and ready finances are needed for your Thailand visit The required documents are outlined here:

  1. Passport,
  2. Tourist Visa Category MT,
  3. To and Fro flight tickets,
  4. Recent bank statement
  5. Letter from the hospital indicating duration and purpose of treatment and,
  6. Medical reports.
What are the popular procedures available in Thailand?

Many reasons make Thailand an attractive medical tourism destination. Low prices, excellent healthcare systems and numerous tourist attractions together ensure that remains one. There are several popular procedures in Thailand such as the ones mentioned below:

  1. Eyelid surgery procedures,
  2. Rhinoplasty,
  3. Breast augmentation,
  4. Laser treatment,
  5. Dental treatments,
  6. Spine and orthopaedic treatments,
  7. Cardiac treatments,
  8. Infertility treatments,
  9. Bariatric surgery,
  10. Ophthalmology and eye surgery.
Is it mandatory to take vaccinations before going to Thailand?

Immunisations and vaccinations are an essential part of any international travel. Do get yourself the necessary protections before you land in Thailand as well. All such vaccinations recommended by CDC and WHO are mentioned here for your convenience. Measles, Mumps and Rubella (MMR), TDAP (Tetanus, Diphtheria and Pertussis), Chickenpox, Shingles, Pneumonia, Influenza, Rabies, Meningitis, Polio, Hepatitis A, Hepatitis B, Typhoid, Cholera and Yellow Fever.

What are the other facilities provided by hospitals in Thailand?

The medical and surgical equipment used in Thailand is upgraded regularly with the latest technological advancements. Your travel, transfer and accomodation needs are coordinated at the center for International patients at Thailand hospitals. Integrated medical support services and emergency services are present at Thailand hospitals. Radiology services, operating theaters, Intensive care units, cardiac care units, diagnostic laboratory and pharmacies are the different kinds of facilities being provided by Thailand hospitals.

What are the major medical tourism destinations in Thailand?

The combination of its excellent existing healthcare infrastructure and the various tourist attractions make Thailand a viable medical tourism destination. What you will spend in Thailand as a medical traveller will still be lower than what you will spend on just your treatment in many countries. The many medical tourism destination in Thailand have a strong foundation of natural beauty, history, culture and the best of healthcare. Phuket and Bangkok are the topmost destinations in medical tourism in Thailand.

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