Pancreatic and Biliary Disorders Diagnosis and Treatment

Ultrasound, CT scans and MRI of your abdomen are nonsurgical imaging tests. They can provide details about gallstones, biliary tract blockages and potential growths or biliary cancer (cholangiocarcinoma). These scans are painless and do not require anesthesia.

ERCP is an endoscopy that diagnoses and treats pancreatic, biliary and gallbladder conditions without surgery. This test uses fluoroscopy (live, moving X-rays) and an endoscope (thin, lighted tube) to view these organs with a high level of detail.

EUS produces images inside your body that provide more detail than an exterior ultrasound. Our specialists use EUS to diagnose bile duct blockages, gallbladder disease, pancreatic pseudocysts, pancreatitis and tumors in the pancreas or bile duct.

This noninvasive test combines magnetic resonance imaging (MRI) and contrast dye to produce images of the bile ducts, gallbladder and pancreas. We may recommend MRCP if ERCP isn’t right for you. This test may also be appropriate if you have a low risk of serious pancreatic or biliary conditions.

PTC is a fluoroscopy that shows how your bile ducts are working. The images can reveal whether the bile ducts are narrowing or blocked. Our specialists may recommend PTC if ERCP isn’t right for you.

ERCP is both a diagnostic test and a treatment procedure. If our specialists find gallstones or other blockages during ERCP, we may remove them. Our ERCP procedures include:

• ERCP dilation: This procedure uses a tiny balloon to widen a narrowed bile duct.
• ERCP sphincterotomy: If you have a narrowed sphincter of Oddi (muscle that controls flow of bile and pancreatic fluids), this procedure improves the duct’s drainage.
• ERCP stent placement: A narrowed biliary or pancreatic duct that cannot stay open on its own may require a stent (narrow tube) to hold the duct open.

Necrotizing pancreatitis is a serious complication of acute pancreatitis. This condition causes part of the pancreatic tissue to die. In some cases, the dead tissue can cause an infection, which can be life-threatening.

Our advanced endoscopists are among the few who treat severe cases of infected necrotizing pancreatitis with endoscopy. We use tiny endoscopic tools to view and remove the affected tissue. There are no outside incisions, so you have a shorter recovery.

Our internationally recognized team performs a high volume of minimally invasive, robotic-assisted and traditional surgery for the bile ducts, liver, gallbladder, pancreas and spleen. This specialized area of surgery requires an experienced, skilled team and advanced technology. 

Our pancreatic and biliary tract surgeries include:

• Whipple Procedure, Distal Pancreatectomy and Total Pancreatectomy: These operations remove all or part of the pancreas. Virginia Mason Franciscan Health is a world leader in the surgical treatment of bile duct and pancreatic cancer. We perform a large volume of these surgeries a year, far more than most other centers. Our outcomes are consistently better than the national average. We use innovative post-surgery recovery techniques that allow you to go home six to seven days after the procedure.      
• Irreversible electroporation (IRE): This technology uses ultrasound imaging and electrical pulses to destroy cancer cells and can treat locally advanced pancreatic tumors in select patients who cannot have their tumors removed. 
• Hepatic Artery Infusion Pump (HAIP) chemotherapy: Our hospital is one of only a few that offer this therapy for patients with colorectal cancer metastasis to the liver and cholangiocarcinoma (a rare type of cancer in the bile ducts).                     
• Repair of bile duct injuries and strictures: Our surgeons commonly repair complex injuries to the bile duct, including the most difficult-to-treat cases. 
• Surgery for choledochal cysts: Our hospital is among the most experienced in North America in treating adults with these rare bile duct cysts. Without treatment, choledochal cysts can turn into cancer. 
• Pancreatic cyst resection: Our multidisciplinary team carefully evaluates pancreatic cysts and uses minimally invasive techniques to remove pancreatic cysts when findings raise concerns about cancer. 
• Liver surgery: Our liver surgeons work with a multidisciplinary team of specialists who thoroughly review your case and recommend the best care for you. We treat all liver diseases that require surgery, including metastatic and primary liver cancers, bile duct strictures and liver cysts. Our team is skilled in traditional, laparoscopic and robotic-assisted surgery as well as microwave ablation and IRE for liver tumors that cannot be removed with surgery.
• Surgery for pancreatitis: Our surgeons have extensive experience and a high success rate in surgery for complicated acute pancreatitis and chronic pancreatitis.