Therapeutic Endoscopy
The endoscopy unit has a major role in providing a therapeutic service within the liver and pancreatic cancer team. This service has been considerably expanded to meet the demands of a very busy HPB centre. There are now four very experienced endoscopists who provide 4 ERCP lists per week and are currently responsible for approximately 550 cases per annum. This allows the service to be very responsive with immediate access for urgent cases. This is an important aspect of the extremely close working relationship between the surgical, radiological and endoscopic components of the HPB unit.
The endoscopic service is particularly focused upon the high proportion of patients in whom palliative management of malignant bile duct obstruction is required. There is a ready accessibility to the use of self expanding metal stents which incorporates many complex cases including those with hilar liver involvement. Gastric and duodenal obstruction is frequently encountered and the unit has considerable experience of metal stenting to provide palliation in such cases.
Provision of endoscopic intervention for benign pancreatic disease is part of the HPB centre remit. This is a rapidly expanding practice particularly for the management of the pain associated with chronic pancreatitis. The endoscopy unit also offers one of the few tertiary referral practices for the diagnosis and management of sphincter of Oddi dysfunction.