Bile ducts are slender tubes that carry the digestive fluid, called bile. Bile ducts are an essential part of the human digestive system as it connects the liver to the gallbladder and to the small intestine. The gallbladder is an organ located on the right side of the body below the liver and contains bile juice. This juice helps in digestion and carries wastes like cholesterol and bilirubin.
A gallbladder stone is formed when there is too much cholesterol or bilirubin in the bile juice. The sizes of gallbladder stones can vary from a grain of rice to the size of a golf ball. Some people may have only one stone while others can have multiple stones. People may have a stone in their gallbladder but might not even know about it due to lack of symptoms. These stones are not detected unless they cause pain or block a bile duct which leads to jaundice.
Symptom of Gallbladder Stones
Some of the symptoms of stones in the gallbladder are pain in the upper mid-abdomen or upper right abdomen, pain in the right shoulder, chest pain, high temperature, nausea, vomiting and jaundice. People tend to ignore these symptoms due to which 10% of total stone cases have been reported to become difficult stones that are almost impossible to be treated with standard treatment.
Causes of gallstones
Several reasons that can increase the risk of gallbladder disease are obesity, diabetes mellitus, metabolic syndrome, an unhealthy diet like packed food and decreased physical activities. The hard stones are developed when the liver makes more cholesterol than the bile can dissolve.
In India, 6.12% of the adult population suffers from gallstones, according to Journal of Family Medicine and Primary Care (2019). As a result, a large population lives with the symptoms and pain for their whole life without realizing the problem. These stone-like deposits in the bile duct or gallbladder vary in size and sometimes require medical treatment. The complex problem of pancreaticobiliary disorders can be life-threatening, and people who experience severe symptoms need surgery for treatment. If these are not treated, it can lead to bile duct cancer.
What is Bile Duct Cancer?
Bile duct cancer is also called cholangiocarcinoma. There are two types of bile duct cancer:
Intrahepatic bile duct cancer: This type of cancer forms in the bile ducts inside the liver. Only a small number of bile duct cancers are intrahepatic.Extrahepatic bile duct cancer: This type of cancer forms in the bile ducts outside the liver. The extrahepatic bile duct is made up of the hilum region and the distal region. Cancer can form in either region.Perihilar bile duct cancer: This type of cancer is found in the hilum region, the area where the right and left bile ducts exit the liver and join to form the common hepatic duct.Distal bile duct cancer: This type of cancer is found in the distal region. The distal region is made up of the common bile duct which passes through the pancreas and ends in the small intestine.
Treatment options
Gallstones are undetected unless there is any pain caused. In most cases, it is not important to have surgery, if there is no other complications involved. If a person experiences symptoms because of the stones, he/she must go through surgery as soon as possible in which the gallbladder is removed through a process known as cholecystectomy. The doctor may use one of these methods to remove the gallstones.
Laparoscopic cholecystectomy – In this procedure, a narrow tube named a laparoscope passes through a small cut into the stomach and mostly the same day the person is discharged.Open cholecystectomy – In this, a bigger cut is required in your stomach to remove the gallbladder. In this surgery mostly the patient must stay in hospital for a few days. In the case of stones going into the bile duct, the doctors mostly use endoscopic retrograde cholangiopancreatography (ERCP) to find it and remove it before or during the time of surgery. If these stones are too large, your doctor might need to break them into smaller fragments before removing them from the bile duct.
Importance of Cholangioscopy
In cholangioscopy, your doctor can directly examine your bile duct and perform surgical procedures there. Due to the advancements in medical technology, cholangioscopy performed using the SpyGlass DS System enables high-resolution imaging and therapy during an ERCP procedure. This is helpful to fragment large stones in the bile duct stones, which may result in effective removal of these difficult stones without the need for open surgery. Also, it can help perform targeted biopsies when bile duct cancers are suspected and thus provides more efficient evaluation and helps reduce the need for additional testing and repeat procedures compared to traditional ERCP. In this way it provides faster, more definitive cancer diagnosis by allowing clinicians to obtain biopsies of tissue under direct visualization, improving sensitivity and diagnostic yield and helping to start treatment early.
Dr Nitin Gupta is a senior consultant in the department of Gastroenterology at Rajiv Gandhi Cancer Research Institute, Rohini. Views expressed are personal.
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