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Related Papers
by Dr. Snady

EUS: An effective New Tool for GI Tumors

Role of EUS in Outcome of GI Diseases

EUS compared w/CT plus ERCP

Artifacts and Techniques of EUS

Stones

Stones of the gastrointestinal system are most frequently found in the gallbladder and diagnosed with a standard sonogram from outside the body. When they cause symptoms, often the most effective treatment is the removal of the gallbladder and the stones, often with a laparoscope that is inserted into the abdomen through surgical openings less than 1 inch.

Stones can also occur in the bile duct or pancreatic duct. Stones in these locations can usually be diagnosed with standard blood tests and an accurate patient history. A standard sonogram is often misleading and usually not helpful. The presence of stones in the ducts are then confirmed and treated using a side viewing endoscope for a technique called therapeutic ERCP (Endoscopic Retrograde CholangioPancreatography). During ERCP dye is injected into the bile duct and pancreatic duct. Stones can then be seen with x-ray and then removed through the side viewing endoscope. However, ERCP does have at least a 5% complication rate associated with it, although most complications are not major or severe. Therefore, ERCP is best used when there is a high probability of performing a therapeutic technique, since EUS has an extremely low complication rate and is as accurate in finding stones. If the diagnosis is in doubt, EUS can be used as a alternative to ERCP to determine the best treatment plan. A new method, MRCP (Magnetic Resonance CholangioPancreatography), is better than standard sonography or CT scan to look for stones. But, MRCP is not correct often enough that it is best used when stones are more likely not present.

These days, the treatment of stones in any location rarely requires an open operation.