Removal of Biliary Tract Stones

Removal of bile duct stones is possible with endoscopic procedures called ERCP.

Symptoms: Bile duct stones can cause severe pain, usually lasting 6-8 hours, pain on the right side and stomach, jaundice, back pain, fever, chills.

Abdominal ultrasonography, biliary tract MRI or endoscopic ultrasonography are used in the diagnosis.

As bile duct stones cause difficulty in the flow of bile into the intestine, they cause an increase in pressure in the liver and enlargement of the bile ducts inside and outside the liver. Therefore, they must be removed.

The ERCP procedure can be performed with a side-view endoscope and x-ray machine. First of all, the patient is put to sleep as in other endoscopic methods. Then, by passing through the stomach with the device, the canal (ampulla vatery) where the bile and pancreatic ducts flow into the duodenum is found. From here, the bile duct is entered through the guide wires and through. Then, imaging is performed under x-ray by giving opaque material. After the location of the stone is determined, a small incision is made at the mouth of the canal. The stone is either pulled out by inflating the balloon behind it or caught with the help of a basket called a basket and taken out.

Processing time

 Depending on the anatomical structure of the patient and the experience of the operetta, it can take between 15 minutes and 1.5 hours.

Gallbladder Stones

In Western society, it is believed that gallstones are more common in middle-aged, white-skinned, obese and multiparous women. (Female, Fat, Forty, Fertile, Fair). Stone or sludge is detected in the gallbladder in approximately 1/3 of people over 60 years of age. Although bile sludge formation in the gallbladder is common during pregnancy, most of them disappear spontaneously after pregnancy. Rapid weight loss can lead to the formation of gallstones in some people.

While gallstones are rare in Asian and African women, gallstones are found in approximately 90% of middle-aged American Indian women. The frequency of stone formation is increased in hemolytic blood diseases caused by the breakdown of red blood cells, liver cirrhosis (especially alcohol-induced liver cirrhosis), diabetics and those with a congenital anomaly in the biliary tract.

For this reason, it is thought that many different factors such as heredity, age, diet, hormonal changes and drugs used may be effective in the formation of gallstones. In practice, it should be noted that gallstones can be seen at any age and in any gender.

What are the Symptoms of Gallstones?

In the vast majority (80%) of patients with gallstones, there is no finding that may belong to the stone. However, when patients with gallstones are followed up, it is known that half of these patients become symptomatic over time. Gallstones can cause the following symptoms;

Pain: It is felt as a pain felt in the upper-middle and/or upper right side of the abdomen, under the ribs, that gets worse, can spread to the shoulder and back, and may be accompanied by nausea and vomiting. The pain that can come suddenly in the form of colic usually occurs after the contraction of the gallbladder after a meal. After the contraction of the gallbladder, the stone in the bladder slides into the neck area of the bladder and gets stuck here, and the stretching of the gallbladder and the neck of the bladder causes pain. The pain can last from a few minutes to several hours.

Sometimes, small bladder stones can cause pain by falling into the biliary tract. In this case, additional findings such as darkening of urine color and lightening of stool color may occur. When inflammation is found with the stone, jaundice, chills, chills and fever can be seen. It should be noted that the symptoms may be milder and atypical in the elderly.

Gallbladder inflammation (Inflammation-inflammation): Sometimes stones can cause inflammation in the gallbladder, and this can vary from mild or moderate pain felt in the form of blunt and fullness in the gallbladder region to severe pain that may be accompanied by nausea, vomiting, chills, chills and fever. can create. This picture is known as acute cholecystitis and is a serious condition.

Jaundice: When gallstones fall into the biliary tract, they can prevent bile from flowing into the intestines, causing yellowing of the whites of the eyes and skin, darkening of the urine color and lightening of the stool color (yellow-dirty dark white stool). This condition is called obstructive jaundice and is due to the increase in the blood level of the pigment called bilirubin in the bile, which cannot flow into the intestine, and is excreted in excess in the urine.

Pancreatitis: When gallstones fall into the biliary tract, it can cause obstruction in the pancreatic duct along with the bile duct, causing acute pancreatitis (See the relationship of the bile and pancreatic ducts in an anatomical way). In acute pancreatitis, the general condition of the patient deteriorates rapidly with severe pain felt in the middle and upper parts of the abdomen and may spread to the sides in the form of a belt and spread to the back. The patient needs hospitalization, monitoring and treatment, and can be fatal if left untreated.

Diagnosing Gallbladder Stones

The diagnosis is made by the application of some imaging methods upon the suspicion of the physician who listens to the patient’s complaints and performs the physical examination. Ultrasonography is the most effective imaging method used in the diagnosis of gallstones. With a good ultrasonography, whether there is stone or sludge in the gallbladder can be detected with an accuracy close to 100%. In some cases, your doctor may want other tests that examine the functioning of the gallbladder in addition to ultrasonography. In cases where the gallbladder is inflamed (acute cholecystitis) and gallstones are suspected to have passed into the biliary tract, computed tomography of the abdomen (CT) and/or Magnetic Resonance imaging (MR) are other radiological examinations that can be used to assist in diagnosis. After clinical, biochemical and radiological tests, the method to be applied when it is suspected that gallstones have fallen into the bile ducts is ERCP, (Endoscopic Retrograde Cholangio Pancreotography) (See Endoscopy, ERCP). In this method, besides the diagnosis, it is also possible to remove the stones that fall into the biliary tract.

Treatment of Gallbladder Stones

Since the majority of patients with gallstones do not develop any symptoms, it is recommended to monitor patients at regular intervals.

Since fatty and egg foods cause contraction of the gallbladder, consuming such foods can sometimes lead to the onset of pain, but a person who has gallstones incidentally does not need to follow a special diet.

In diabetic patients and those with porcelain gallbladder, surgical removal of the gallbladder (cholecystectomy) is recommended under elective conditions without any symptoms. The treatment method to be recommended in patients who become symptomatic is laparoscopic cholecystectomy (removal of the gallbladder by means of videoendoscopic imaging and several holes opened in the abdominal wall without making a large incision).

With this method, the hospital stay is shortened and the patient can be sent home within 24-48 hours after the operation. In cases where laparoscopic cholecystectomy cannot be performed, the method of choice is open surgery cholecystectomy. ERCP is the method to be used for removing stones that fall into the biliary tract, and it is generally recommended to be performed before cholecystectomy.