What we do - information for patients 


Conditions we specialise in treating

Pancreaticobiliary cancers
We offer a comprehensive service to patients with suspected or confirmed cancer of the pancreas or bile duct. In discussion with our patients we offer a range of procedures to confirm the exact diagnosis. We assess the cancer and offer a range of treatments in collaboration with our surgical and oncology colleagues for the cancer or it’s complications, like jaundice, to allow the best possible outcomes.

Gallstones 
Gall stones are a common cause of abdominal pain and jaundice. We specialise in the removal of particularly challenging stones from the bile duct. We also offer EHL (electrohydraulic lithotripsy) where required which means very large stones can be managed endoscopically by shattering them under direct vision at the time of cholangioscopy rather than requiring surgery.

Biliary strictures
With our experience and resources of highly specialised endoscopy (ERCP, EUS and cholangioscopy) we are able to diagnose and treat strictures of the bile duct.

Acute pancreatitis
Inflammation of the pancreas causes severe abdominal pain and can be life threatening or lead to serious complications. We are experts in the diagnosis of the cause of recurrent attacks of pancreatitis and also admit patients from other hospitals around the region who need our specialist care for severe attacks of pancreatitis.

Chronic pancreatitis
We assess patients with chronic pancreatitis in our out-patients unit. The aims of the service are to determine the cause of the pancreatitis; evaluate and treat any complications; and determine a strategy of alleviating the pain of chronic pancreatitis such as endoscopic pancreatic therapy in close liaison with our surgical colleagues at the Royal Free Hospital.

Sphincter of oddi dysfunction
This condition is thought to be caused by spasm of the sphincter muscle at the bottom of the bile duct. It leads to long term pain in the abdomen which can be debilitating. We are referred patients from doctors who think this might explain their patients symptoms. We then spend time with the patient in the clinic and judge whether they would benefit from an ERCP and direct measurement of the sphincter pressure (sphincter of oddi manometry)

Pancreatic cysts
Cysts of the pancreas are quite common, and are often found incidentally when an abdominal scan is done for other reasons. We offer a service to patients to determine the nature of these cysts and whether any particular treatment is needed.

 

Procedures we perform

ERCP
ERCP is the commonest procedure we perform for treat problems within the bile duct and pancreas. A flexible endoscope is passed through the mouth, and is passed into the bowel just beyond the stomach to the opening of the bile duct and pancreatic duct. Using x-ray screening and contrast agent a wire and tube is placed into either the bile duct or pancreas. Treatment can then be undertaken such as removal of gallstones, taking tissue samples, and inserting a stent (tube) into blocked ducts to enable drainage and alleviate jaundice.

EUS
This procedure is used to obtain very detailed images of the anatomy around of the upper bowel, pancreas and bile ducts. An endoscope fitted with a tiny ultrasound probe is passed though the mouth into the stomach and upper bowel. Needles can be used through the scope to sample tissue and sometimes undertake other treatments such as a nerve block or cyst drainage.

Cholangioscopy
This is when a very small endoscope is passed through the lumen of a standard endoscope during an ERCP. This small endoscope can be passed into the bile duct and liver and used to evaluate and biopsy strictures of the bile duct, and also directly smash gallstones using EHL (electrohydraulic lithtrypsy).

Enteral stenting (stenting of pylorus, duodenum and colon)
Sometimes certain types of cancer can cause a blockage to the bowel. It is sometimes possible to reach the blockage with an endoscope and insert a metal stent to open the narrowing and relieve the symptoms of obstruction.

Percutaneous and trans-hepatic biliary intervention
Sometimes we cannot access the bile duct from the bowel, particularly if a patient has had surgery such as a gastric by-pass operation for obesity or a Whipples resection. Our radiology colleagues are able to gain access to the bile duct by passing a tube through the liver and into the bile duct to relieve jaundice and undertake other treatments like stenting.

Sphincter of oddi manometry
Spasm of the sphincter muscle at the bottom of the bile duct can lead to long term pain in the abdomen which can be debilitating. We sometimes arrange for an ERCP and direct measurement of the sphincter pressure. If these are elevated making a small cut into the sphincter can relieve the pain.

 Contact details

Pancreatobiliary service
University College Hospital
UCLH contact centre
Ground floor central
250 Euston Road
London, NW1 2PG

Patient enquiries
Telephone: 020 3447 9229

GP enquiries
Telephone: 020 3447 9229
Fax: 020 3447 9218
Email: r.bombusa@nhs.net

Other information
Dylan Smiley (for HPB medicine) / William Mcintyre (for HPB surgery)

dylan.smiley@uclh.nhs.uk  / William.Mcintyre@uclh.nhs.uk