Endoscopic Procedures

What are Endoscopic Procedures?

Endoscopic procedures for the gallbladder are minimally invasive techniques used to diagnose and treat various gallbladder diseases, such as gallstones, gallbladder inflammation (cholecystitis), and gallbladder cancer. 

Who is Suitable for Endoscopic Procedures?

An individual's suitability for endoscopic procedures depends on several factors, including the type and severity of the gallbladder disease, the overall health status of the patient, and their ability to tolerate the procedure. For example:

• Patients with symptomatic gallstones or cholecystitis who are otherwise healthy are often suitable candidates for ERCP or laparoscopic cholecystectomy.
• Patients with suspected gallbladder cancer might undergo EUS for diagnosis and staging, but more invasive surgery might be required if the cancer is advanced.
• Those with serious health conditions or not fit for surgery might be more suitable for non-surgical treatments, such as oral medication to dissolve gallstones or shock wave lithotripsy to break them up.

Always consult your doctor for the best advice based on your condition and circumstances.

Benefits of Endoscopic Procedures

• Minimally Invasive: Endoscopic procedures are less invasive than traditional open surgery. They generally involve fewer and smaller incisions, which can lead to less post-operative pain and faster recovery times.
• Shorter Hospital Stay: Patients undergoing endoscopic procedures often have a shorter hospital stay and can sometimes even go home the same day.
• Lower Risk of Complications: Endoscopic procedures are typically associated with a lower risk of complications, such as infection and bleeding, compared to open surgery.
• Improved Diagnostic Accuracy: Procedures like ERCP and EUS can provide detailed images of the gallbladder and surrounding structures, improving the accuracy of diagnosis.

Types of Endoscopic Procedures for Gallbladder

• Endoscopic Retrograde Cholangiopancreatography (ERCP): This is a procedure used to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It combines X-ray and the use of an endoscope.
• Endoscopic Ultrasound (EUS): This imaging procedure diagnoses gastrointestinal tract diseases, including the gallbladder. It combines endoscopy and ultrasound.
• Laparoscopic Cholecystectomy is a minimally invasive surgical procedure to remove the gallbladder. It uses a laparoscope inserted into the abdomen through small incisions.

Alternative Options to Endoscopic Procedures

• Open Cholecystectomy: This is a more invasive surgical procedure where the surgeon removes the gallbladder through a large incision in the abdomen. It may be necessary if laparoscopic surgery is not an option.
• Medications: Certain medications can help dissolve gallstones. However, this can take months or years; gallstones can re-form if treatment is stopped.
• Extracorporeal Shock Wave Lithotripsy (ESWL): This non-invasive treatment uses shock waves to break up gallstones.
• Percutaneous Cholecystostomy: This is a procedure where a tube is inserted through the skin directly into the gallbladder to drain bile and relieve symptoms. This is often used in patients who are too ill to undergo surgery.
• Observation or Lifestyle Changes: For some people with gallstones that don't cause symptoms, a "wait and see" approach may be recommended. Changes in diet and lifestyle can also help manage symptoms and prevent further gallstone formation.

Preparation for Endoscopic Procedures for Gallbladder

• Medical History: The doctor will want to know the patient's medical history, including any conditions they have, the medications they are currently taking, and any allergies they may have.
• Fasting: The patient is typically asked to fast (no food or liquids) for several hours before the procedure to ensure the stomach is empty.
• Informed Consent: The doctor should explain the procedure, its benefits, risks, and alternatives, and the patient must provide informed consent.
• Medication Adjustments: The doctor may instruct the patient to stop taking certain medications or supplements that could increase the risk of bleeding.

What Happens During an Endoscopic Procedure?

• Sedation: Patients are usually given sedatives to help them relax and possibly fall asleep during the procedure.
• Insertion of the Endoscope: In ERCP or EUS, the doctor inserts a thin, flexible tube (endoscope) through the mouth, down the oesophagus, and into the stomach and the first part of the small intestine.
• Imaging and Intervention: Depending on the procedure, the doctor may inject a contrast dye to help visualise the gallbladder and bile ducts, break up or remove gallstones, take tissue samples, or perform other necessary interventions.

Recovery from Endoscopic Procedures

• Observation: After the procedure, the patient is taken to a recovery room for observation while the sedative wears off.
• Pain Management: Pain is usually mild and can be managed with over-the-counter or prescription pain relievers.
• Diet and Activity: The doctor will provide diet and physical activity instructions. Most people can return to their regular diet and activities within a few days.
• Follow-Up: A follow-up appointment is usually scheduled to discuss the procedure's results and any further treatment that may be needed.
• Monitor for Complications: While complications are rare, it's important to contact the doctor if the patient experiences severe abdominal pain, fever, bloating, nausea or vomiting, changes in bowel habits, yellowing of the skin or eyes (jaundice), or other concerning symptoms.

Prognosis after Endoscopic Procedures

For many people, endoscopic procedures can significantly relieve symptoms and improve their quality of life.

• For gallstones, endoscopic procedures like ERCP can often successfully remove stones from the bile ducts, and a laparoscopic cholecystectomy can prevent future gallstone-related complications by removing the gallbladder itself.
• Surgical gallbladder removal typically resolves the inflammation and associated symptoms of gallbladder inflammation or cholecystitis.
• For gallbladder cancer, the prognosis depends on the stage of the disease. If the cancer is localised and surgery is possible, the prognosis is generally better, but advanced gallbladder cancer has a less favourable prognosis.

Risks of Endoscopic Procedures

Like all medical procedures, endoscopic procedures for gallbladder carry some risks, although these are typically quite low. Possible complications can include:

• Infection
• Bleeding
• Reaction to anaesthesia or sedation
• Injury to the gallbladder, bile ducts, liver, or intestines
• In the case of ERCP, there is a risk of pancreatitis (inflammation of the pancreas)