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 the United Arab Emirates has different inclusions and exclusions. The ERCP (Diagnostic) package cost usually includes all the expenses related to pre and post surgery expenses of the patient. Typically, the package cost of ERCP (Diagnostic) in the United Arab Emirates includes the expenses related to the surgeon's fee, anesthesia, hospital, meals, nursing and ICU stay. A prolonged hospital stay due to delayed recovery, new diagnosis and complications after surgery may increase the cost of ERCP (Diagnostic) in the United Arab Emirates.
Upon discharge from the hospital after ERCP (Diagnostic) in the United Arab Emirates, the patients are advised to stay for about 3 days for recovery. This period is important to conduct all the follow-up tests to ensure that the surgery was successful and the patient can go back to the home country.
the United Arab Emirates is considered to be one of the best places for ERCP (Diagnostic) in the world. This is because of the availability of some of the best doctors, advanced medical technology and good hospital infrastructure. Some of the other destinations that are popular for ERCP (Diagnostic) include the following:
Apart from the ERCP (Diagnostic) cost, the patient may have to pay for additional daily expenses such as for guest house after discharge and meals. The extra charges may start from USD 50 per person.
Some of the cpopular cities in the United Arab Emirates that offer ERCP (Diagnostic) include the following:
It is possible for patients to opt for video telemedicine consultation before they come for ERCP (Diagnostic) in the United Arab Emirates. Some of the surgeons offering this service include the following
|Doctor||Cost||Schedule Your Appointment|
|Dr. Mahesh Rama Varma||USD 173||Schedule Now|
|Dr. Xavier Garcia Aguilera||USD 173||Schedule Now|
|Dr. Yogesh Manohar Shastri||USD 173||Schedule Now|
The patient is supposed to stay at the hospital for about 1 day after ERCP (Diagnostic) for monitoring and care. 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.
The average rating for ERCP (Diagnostic) hospitals in the United Arab Emirates is 4.5. This rating is calculated on the basis of different parameters such as attitude of the nurses, cleanliness, quality of food and the pricing policy.
There are more than 3 hospitals that offer ERCP (Diagnostic) in the United Arab Emirates. These hospitals have proper infrastructure for the treatment of patients who require kidney transplant. 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.
The UAE healthcare system is accredited by the DHCA (Dubai Healthcare City Authority) and JCI (Joint Commission International). UAE Hospitals quality standards in patient service delivery, medical care and hospital infrastructure is overseen by the DHCA and JCI. Known as the governing body of Dubai Healthcare City, DHCA streamlines hospital facilities in UAE whereas JCI is a non profit accredition body present in over 100 countries. Dubai Healthcare City Authority was established in the year 2011 and Joint Commission International was founded in 1998 as a division of The Joint Commission (est. 1951).
There are numerous multidisciplinary hospital groups in UAE which are listed below for your convenience:
The good quality of the multispecialty hospitals in UAE is the exceptional medical care at low cost. The scope of procedures that can be performed in the hospitals in UAE is vast as all kinds of specialties are available in the hospitals in the country. The hospitality that UAE is so famous for is also ingrained in the administrative personnel and the healthcare staff manning the various mutlispecialty hospitals making it easy for any medical traveller to navigate the systems.
Healthcare in UAE should be your natural option with its fast growing healthcare sector over the last five decades adding many hospitals, healthcare centers, clinics, rehabilitation centers and related infratstructure. The vision of the UAE government is futuristic in relation with the healthcare sector with the government not just planning but executing these plans to drive growth in this sector. You must choose to get your treatment done in UAE as the high standards of care healthcare organisations provide to their patients is aligned with their well organised and seamless systems You can decide to get treatment done in UAE as it has an amalgamation of a strong healthcare sector and a thriving travel ecosystem inclusive of hotels, aviation and transport logistics.
It is mandatory for the doctors in UAE to obtain a license to practice their chosen area of medicine thus ensuring that only the best among them get to practice medicine and treat people. Doctors working in the hospitals in UAE are qualified, experienced and stay up to date with the latest developments in their area of expertise. The personal touch they bring to their skill helps patients feel comfortable. The doctors in UAE treat a wide variety of patients from all walks of life and from different nationalities.
All documents need to be checked before coming to UAE for your medical treatment. The documents are essential for the reason that they make your journey and related medical treatment a seamless process. The documents required for medical travel to UAE are related to your travel and for the medical treatment that you are undergoing. Please ensure that you carry essential documents to UAE as mentioned below.
Popular procedures being performed in UAE are as follows.
It is heartening that cosmetic surgery has found a place in the list of popular procedures in UAE and among these botox and fillers are most common. Fertility treatments are also showing a positive growth trend and this positive trend is helped by the proactiveness of the government in UAE in forming new legislation and building a positive environment. Skilled and experienced doctors perform the popular procedures in UAE at budget friendly costs.
It is essential to take pre travel vaccinations prior to your UAE travel. As you begin preparing for your journey get vaccinated atleast four weeks in advance. The country of origin or destination (if going from UAE), length of stay, health conditions and current doctors' prescriptions are the major factors in the kind of vaccines and their dosage. Do get the yellow fever vaccination for Central African for South American countries.
Medical tourism in UAE is made attractive by many factors and one of them includes the facilities provided by hospitals. It is the seamless functioning of public and private healthcare systems that give wonderful additional hospital facilities. The international patient centers in hospitals in UAE ensure comprehensive coordination facilities for medical tourists at one place. International patient centers are making the medical travellers lives easy by helping them in many ways such as:
Medical tourism is an industry which is on the fast track of growth in UAE. In no small measure, Abu Dhabi and Dubai are two most important medical tourism destinations and they are growing exponentially. The technologically advanced healthcare infrastructure and a continued focus in bringing it up to date with the latest innovations is a commonality with both Dubai and Abu Dhabi. The health tourism sector is rising fast in UAE on account of the increasing medical travellers headed to Dubai and Abu Dhabi post good investment in healthcare infrastructure and strong healthcare regulations.
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