Re: Question about Common Bile Duct Stricture

Hi Teresa,

I have a few comments:

You wrote:

The Doctor that performed the EUS had noted the Common Bile Duct was somewhat thickened at 2-3mm, but not such to make one think of Cholangiocarcinoma.(?)

You put a question mark in there. I'm afraid I'm not sure what your question is. This note seems pretty clear to me. The bile duct was thicker than normal. But not as thick as what they usually see in cholangiocarcinoma.

You wrote:

The CBD had no tumor associated with the pancreas causing the compression.

A portion of the common bile duct sits inside pancreas. Think of it as a pipe going into a tunnel. In some patients, the stricture (narrowing) of the bile duct is caused by pancreatic cancer. Pancreatic tumor compresses the bile duct. Your mom's report says she doesn't have that. This is great news.

You wrote:

He stated later on in his notes, I cannot be certain that this is not an early Cholangiocarcinoma however there was nothing to be sampled by FNA.(?)

FNA = Fine Needle Aspiration. EUS doctor can extend a fine needle from the endoscopic probe and stick it into surrounding organs. They can use this fine needle to collect a tiny amount of tissue for biopsy. I don't understand why he wrote "there was nothing to be sampled by FNA". I don't know enough to even begin to speculate.

In my wife's case, the doctor noted that he had *chosen* not to sample the stricture by FNA. He was afraid to cross-contaminate the surrounding organs with cancer cells, if the stricture was truly cholangiocarcinoma.

You wrote:

I could not find where he had the size of the original stent, just that he had replaced it with the 10 French 5 cm long stent.

Sorry Teresa, I think I managed to confuse you. The sizes of the stents are not important. What's important is the size of the stricture (the narrowing of the bile duct).

Here's how our surgeon explained his plan. Do the first ERCP. Measure the stricture. How long and how tight it is. Wait 6-8 weeks. Do the second ERCP. Measure the stricture again. If the stricture is smaller on the second ERCP, it helps to rule out cancer. Cancerous strictures do not shrink between ERCPs. My wife didn't get to do the second ERCP. We did EUS after the first ERCP. EUS doctor was pretty sure that my wife had cholangiocarcinoma. So we decided to go to surgery without waiting for the second ERCP.

Any questions - please do not hesitate to ask.

Best wishes,
Eli

Re: Question about Common Bile Duct Stricture

Hi Teresa,

I am very familiar with Chesterfield.  I used to drive from Staunton to Moorefield Park to attend business meetings.  Now, I have a sister-in-law who is living in Chesterfield.  Small world.  My husband has a friend from highschool who had a liver transplant done at one of the hospitals in Richmond.   I'll try to find out which one.   I know you will love Dr. Adams, and I so hope that you get in fast.  Love,  PeggyP

Re: Question about Common Bile Duct Stricture

Your mother's story reminds me  a bit of my own (which you can read about on here in more detail if you look at my old messages), just under a year ago I went in to see my doctor thinking I was a ,mostly healthy 42 year old man, who was just getting over a broken back due to a fall a few months earlier, on a routine follow up visit, I mentioned I had been experiencing some itching and he did blood work for liver levels which started the ball rolling.  Ultra-sound found gallstones, referral to a general surgeon then to an MRCP which showed a "blockage" in the common bile duct, so the surgeon sent me to a Gastroenterologist for an ERCP, which found the blockage was really a stricture (scraping biopsy negative, but also told they were unreliable in these cases), on to a specialist Gastroenterologist who did a Spyglass ERCP, biopsy again negative, but visually he reported it looked "highly consistant with CC", places a stint to help things flow so on to the speciality liver surgeons.  I have my fist gallbladder pain a few days before my appointment to consult with the surgeons, local doctor puts me on antibiotics knowing I was scheduled to see a surgeon within a few days, I see the surgeon am told it is an 80% chance of CC even with negative biopsies, he is concerend about the gallbladder infection, schedules me in for surgery (ended up getting a Roux-en-Y hepaticojejunostomy instead of Whipple due to placement of the stricture higher up in the bile duct, similar surgery though), surgeon has a CT scan done, and ends up admitting my to the hospital on the spot, gallbladder is highly infected, erored into the liver, looks like the stint blocked the opening to the gallbladder which was already mostly blocked by gallstones, they put a drain in and have me on IV antibiotics for a week, then home for a week or so to let the infection clear up then back for the big surgery with a drain pouch taped to my side.  I have the big surgery and thankfully it turned out the stricture was benign, the surgeon said it was best to do the surgery anyway as even if benign strictures can turn into CC a lot of the time.  Spent a week in the hospital, then several weeks recovering at home, the surgery was rough, but the real issue was the fatigue afterward, even 6-8 weeks later I barely had the strength to drive myself to the store to run short errands.  Anyway I just had my 6 month follow up, liver lelels look good, but the doctors are telling me it will have to be checked every 6 months from here on out.

Re: Question about Common Bile Duct Stricture

Hi,
Yes, you should go back to the doctors to have follow up CT scan done and lab work like CBC,CMP CA19-9,CEA DONE FOR THE GI Doctor to compare.
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: Question about Common Bile Duct Stricture

Here we are almost another year later and more CT Scans, biopsy, blood work, & EUS performed still not showing any signs of cancer. We just visited the Cancer Doctor last week and he told us that he believes that it is Bile Duct Cancer and from the other visits, recommending the Whipple Procedure again to rule out if it is Cancer.

I was wondering, if there is any other reason the Bile Duct can become blocked without being Cancer? It's just, we have been doing this for almost two years and I would have thought something would have showed up in the tests and nothing. Do we take the risk of the procedure after everything she has done, showing nothing or continue to monitor it with the scans and bloodwork?

Re: Question about Common Bile Duct Stricture

Hi,
I think, when in doubt like in your case,go for a 2nd opinion by another GI or liver specialist may be needed. Major hospitals like John Hopkins or Mass General hosp. or New York Pres. hospital etc.
I do not think I can provide any good answers for you.
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: Question about Common Bile Duct Stricture

Hi Teresa,

To answer your question:

I was wondering, if there is any other reason the Bile Duct can become blocked without being Cancer?

Yes, the bile duct can become blocked by a benign stricture. Unfortunately, the existing diagnostic tests cannot reliably distinguish cancerous and benign strictures. They look almost the same on all tests.

Benign strictures can be caused by:

* Inflammation.

* Surgical trauma from prior surgery in the area, such as gallbladder removal.

This is not a complete list. I recall seeing medical papers that discussed about 5-7 different types of benign strictures. I will post the links if I can find them.

Re: Question about Common Bile Duct Stricture

Virginiagal, This is all so confusing but I have one big question. Did you ever get to see Dr. Reid? Hopefully it is not CC but if it is so much time has been wasted. My own personal opinion is you need to see this Dr. Reid, ASAP since it sounded like he was good and he was near you. The Whipple is the largest surgery to the human body. Not life threatening but huge. In all this time now has your Mom got any other symptoms?

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: Question about Common Bile Duct Stricture

Virginiagal...you might want to print out Isaac's posting and take along when visiting the physicians.  Isaac's experience is a case they might want to look at.
Hugs and good luck,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER