Biliopancreatic Disorders: Know The Common Causes, Prevention And Treatment From An Expert

Pancreatic and biliary diseases impact the liver, pancreas, gallbladder, or bile ducts. The bile ducts carry bile from the liver and gallbladder to the duodenum, which is a part of the small intestine. Bile is a dark-green or yellowish-brown fluid secreted by the liver to digest fats. Biliopancreatic disorders are quite common and involve a whole spectrum of diseases from mild to severe, including pancreatic cancers. This increases with diseases like chronic pancreatitis and pancreatic malignancies. Therefore, there is an urgent need to address these disorders.

Following are some of the most common causes of pancreatic and bile duct disease

• Gallstones (hardened deposits of digestive fluids in the gall bladder)
• Inflammation of the bile ducts
• Trauma
• Biliary stricture (when the bile duct becomes smaller or narrower)
• Pancreatic cysts
• Pancreatitis both acute and chronic
• Tumours of the liver, gallbladder, pancreas, or bile ducts
• Liver infections
• Liver failure or cirrhosis
• Choledochal cyst (present in infants at birth)
• Early intervention

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Early diagnosis and treatment of patients with pancreatic and bile duct diseases can lead to better or improved outcomes. Treatment can address the underlying cause of the disease and the primary objective of medical or surgical treatment is to alleviate the blockage in the duct. A delay in treatment can lead to fatal complications such as build-up of bilirubin, infections, sepsis, chronic liver disease and biliary cirrhosis. An ERCP (Endoscopic Retrograde Cholangiopancreatography) is one method to deal with diseases of bile duct and pancreatic duct. It can be used to remove bile duct stones or place a stent inside to restore bile flow. There are other treatment methods available but ERCP is the standard of care as far as management of biliopancreatic disorders are concerned.

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Current breakthrough in treatment

The new single-use duodenoscope is a breakthrough technology in the treatment of patients suffering from bile duct or pancreas duct diseases. It is a hollow, flexible and lighter scope used in ERCP procedure for diagnosis and treatment of bile and pancreatic duct diseases. It is lightweight and specifically designed to decrease the rate of infection, which is very critical while treating such diseases. Infection control is paramount in these patients and the scope offers new duodenoscope offers complete safety, eradicating chances of cross-contamination. Although most ERCP infections are caused to suboptimal ductal drainage, there are chances of transmission of infection by contaminated reusable duodenoscopes. The elevator and distal endcap, particularly in instances where reprocessing of scope is not adequate, make cleaning more difficult and can trap bacteria and debris. To over-come this limitation, the disposable duodenoscope has been recently developed. It can used for the ERCP procedure, allowing direct access to the bile or pancreatic ducts to deliver treatment to reopen ducts that have been closed by tumours, gallstones, inflammation, infection, or other conditions.

Recent case study: A 30-year-old male was experiencing pain in the abdomen, jaundice, and fever. In view of persisting pain and jaundice he was diagnosed with stones in his bile duct. The patient underwent an ERCP procedure with a single use duodenoscope for extracting the stones in the bile duct. He was discharges on the same day with no further complications.

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Some preventive tips to protect against such diseases

• Consume a low-calorie diet and increase the intake of fibre
• Decrease intake of sugar and saturated fats (these can both cause gallstones)
• Quit smoking and reduce alcohol consumption
• Keep weight in check
• Be aware and undergo screening for early intervention

(Dr Rajesh Puri: Director of Gastroenterology, Institute of Digestive and Hepatobiliary Sciences, Medanta)

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