Name of the Procedure:

Biliary endoscopy, percutaneous via T-tube or other tract; with removal of calculus/calculi

Summary

This is a medical procedure where a specialized endoscope is inserted through a T-tube or other tract to remove stones (calculi) from the bile ducts. The T-tube is usually placed after a previous surgery on the bile ducts.

Purpose

The procedure is performed to remove stones from the bile ducts, which can cause pain, infection, or blockages. The goal is to alleviate symptoms and prevent further complications related to bile duct stones.

Indications

• Persistent abdominal pain
• Jaundice (yellowing of the skin and eyes)
• Recurrent bile duct infections
• Abnormal liver function tests suggestive of bile duct obstruction

Preparation

• Patients may be instructed to fast for a certain period before the procedure.
• Adjustments in medications, particularly blood thinners, may be necessary.
• Diagnostic tests such as blood tests, ultrasound, or MRI may be conducted beforehand.

Procedure Description

1. The patient is given local anesthesia with sedation or general anesthesia.
2. An endoscope is carefully inserted through the T-tube or another tract leading to the bile ducts.
3. The physician navigates the endoscope to locate the stones.
4. Specialized instruments fitted to the endoscope are used to capture and remove the stones.
5. The endoscope is then withdrawn, and the site is closed if necessary.

Tools and Equipment

• Endoscope
• T-tube
• Stone retrieval instruments (baskets or balloons)

Anesthesia

• Local anesthesia with sedation or general anesthesia, depending on the case.

Duration

The procedure typically takes between 30 minutes to 1 hour.

Setting

The procedure is usually performed in a hospital or a specialized outpatient surgical center.

Personnel

• Gastroenterologist or specialized surgeon
• Nurses
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Common risks: Infection, bleeding, bile leak
• Rare risks: Pancreatitis, injury to the bile ducts or surrounding organs
• Complication management may involve antibiotics, additional procedures, or extended hospitalization.

Benefits

• Relief from pain and jaundice
• Prevention of recurrent infections
• Improved liver function
• Benefits are usually seen soon after recovery from the procedure.

Recovery

• Patients may need to stay in the hospital for a short period for observation.
• Pain management and antibiotics may be provided.
• Physical activity may be restricted for a few days.
• Follow-up appointments to monitor recovery.

Alternatives

• Observation and symptomatic treatment
• Endoscopic Retrograde Cholangiopancreatography (ERCP)
• Surgical removal of the stones
• Each alternative has its own pros and cons related to invasiveness, recovery time, and effectiveness.

Patient Experience

• Patients may feel discomfort during the insertion of the endoscope if only local anesthesia is used.
• After the procedure, there may be mild pain or soreness at the site of insertion.
• Pain management will be provided to ensure comfort.
• Most patients report significant symptom relief post-recovery.