This treatment at KIST has completely changed the ways patients suffering from gallstones and obstructions in bile duct are treated.   

A few months ago, a 79-year-old woman was suffering from jaundice and severe abdominal pain. The patient’s family was clueless about the cause and anxiously and rushed her to KIST Hospital immediately after her health condition started to degrade. Upon arriving at the hospital, the medical team examined her abdomen and found out that she was infected with cholangitis (infection) due to the blockage of the bile duct by a large 16 mm stone.

Analysing the patient’s critical condition, doctors suggested that surgery was not an ideal option as the infection was spreading quickly, leading to the patient’s low blood pressure. The anxious family was hopeless for her recovery until the medical team led by Dr Kamal Raj Subedi, Consultant Gastroenterologist/ Hepatologist at KIST Medical College Teaching Hospital approached them with a safe solution - Endoscopic Retrograde Cholangiopancreatography (ERCP) treatment.

The team, under the coordination of Dr Subedi, successfully removed the stone and relieved the blockage of the bile duct from the patient's body through ERCP. The patient’s condition quickly improved after the procedure. Dr Subedi informs that the situation of the patient, in this case, was critical and if it had continued, the situation could have been more dangerous.

Amish Pathak, COO, informs that this was the first ERCP treatment performed at KIST Teaching Hospital and Dr Subedi and the medical team since then have been regularly performing ERCP.

ERCP is a minimally invasive procedure done using endoscopy technique without any surgery to remove bile duct stones and to bypass any bile duct obstruction. “This service is not readily available in many institutions in Kathmandu and if available, the patient has to pay a heavy sum for the service,” Pathak informed.

Dr Subedi informs that ERCP is used to treat pancreatic-biliary diseases. “It used to be a diagnostic tool a few decades back, but now it is used primarily for therapeutic purposes. The main aim of ERCP is to relieve obstruction and facilitate proper drainage of the bile duct and pancreatic duct into intestine,” he adds.

“ERCP can cure the obstruction caused by the benign strict by putting multiple stents in multiple sessions and for the obstruction of malignant structure (cancer), ERCP can cure jaundice by putting stents, the cancer part needs to be treated separately with surgery, chemotherapy or radiotherapy,” he opined.

ERCP is a complex procedure, which requires proper training and is followed by exposure to a high volume of cases done by the endoscopist to minimise procedure-related complications. Few endoscopists in Nepal are properly trained to perform ERCP with minimal complications.

“Here at KIST Dr Kamal Raj Subedi performs the specialized ERCP procedure with the team of Gastroenterologists headed by Prof Dr Sita Ram Chaudhary along with Dr Mukesh Prasad Shah, Dr Santosh Gautam, Gastroenterology Surgeons and Anesthesiologists,” Pathak informs. While performing ERCP, patients are sedated, after which an endoscope is passed via the mouth to the stomach and eventually to the Duodenum where the Ampulla (opening of bile duct & pancreatic duct) is located. The stones are removed from that opening and when needed, stents are placed through the same opening. For the identification of diseases, patients need to undergo imaging tests (Ultrasound, CT scan or MRCP/MRI) and blood test (Liver Function Test, PT/INR). Apart from that, the patient needs to have pre-anaesthetic checkup and tests. Patients are advised not to eat or drink anything for 6-8 hours for ERCP.

Dr Subedi says, “Doctors in many hospitals delivering ERCP in Nepal are still a little unaware of the professional practice of ERCP treatments. It is a sensitive procedure and carelessness can lead to casualties, but with a private hospital like KIST, the patient can rely on the service,” he adds.

At KIST Medical College Teaching Hospital, Dr Subedi and his team hopes and believes that even the most complex cases to remove bile duct stones and to bypass any bile duct obstruction are achievable in Nepal with the advancement of technology.