Understanding Gallstone Symptoms and How ERCP Can Treat Them

By: Geraldus Sigap

Gallstones are small, hardened deposits that form in the gallbladder, a small organ located just below the liver. While they may be small, gallstones can cause significant discomfort and even lead to serious complications if left untreated. Fortunately, with advancements in medical technology, a procedure known as Endoscopic Retrograde Cholangiopancreatography, or ERCP, provides an effective solution for treating gallstones and their symptoms. In this article, we will explore the symptoms of gallstones, why they develop, and how ERCP can provide relief, helping you understand the journey to better digestive health.

Figure 1. Gallstones illustration (Mayo Clinic)

Gallstones are made up of substances found in bile, a digestive fluid produced by the liver and stored in the gallbladder. Bile plays an essential role in breaking down fats, and it flows from the liver and gallbladder into the intestines to aid in digestion. However, when there is an imbalance in the bile’s composition, certain substances, like cholesterol or bilirubin, can harden and form into stones. Gallstones vary in size, from as small as a grain of sand to as large as a golf ball, and they can cause blockages in the bile ducts. Gallstones can form for several reasons. High cholesterol levels, for example, can lead to the formation of cholesterol gallstones, which are the most common type. Other factors include an excess of bilirubin (a substance produced by the liver when it breaks down red blood cells) and concentrated bile due to an empty gallbladder. Genetics, diet, and lifestyle can also increase the likelihood of developing gallstones.

Not everyone with gallstones will experience symptoms, but when they do, the discomfort can be quite noticeable. Symptoms occur when a gallstone blocks a bile duct, preventing bile from flowing properly. Here are some of the most common symptoms:

Abdominal Pain: The most common symptom of gallstones is pain in the upper right part of the abdomen. This pain can be intense, often described as a sharp or aching sensation, and may radiate to the back or shoulder blade. It usually occurs after eating a heavy meal, particularly one high in fat.
Nausea and Vomiting: A blocked bile duct can disrupt digestion, leading to nausea and vomiting. This is especially common if the gallstone causes a complete obstruction, as bile can no longer flow into the intestines to aid digestion.
Bloating and Gas: Many people with gallstones experience a feeling of fullness, bloating, and excessive gas, particularly after eating. This is due to the body’s inability to process fats effectively without proper bile flow.
Fever and Chills: If a gallstone causes an infection in the bile duct, it can lead to symptoms such as fever and chills. This is a sign of a more serious complication known as cholangitis, which requires prompt medical attention.
Jaundice: When bile cannot drain properly, bilirubin can build up in the bloodstream, causing the skin and eyes to appear yellow. This condition, known as jaundice, is a sign that the bile ducts may be blocked and should be evaluated by a healthcare provider.
Dark Urine and Pale Stools: A blocked bile duct can also affect the color of urine and stools. Dark urine and pale stools are often indicators of a bile flow issue and can suggest that a gallstone may be causing an obstruction.

Endoscopic Retrograde Cholangiopancreatography, or ERCP, is a specialized procedure used to diagnose and treat conditions affecting the bile ducts, pancreatic ducts, and gallbladder. ERCP combines endoscopy, which uses a flexible tube with a camera, and fluoroscopy, a type of X-ray imaging, to provide detailed images of the digestive system. It allows doctors to both see and treat blockages caused by gallstones in a single procedure.

During ERCP, the doctor guides an endoscope through the mouth, down the esophagus, and into the small intestine. Once the scope reaches the bile ducts, a contrast dye is injected to highlight the ducts on the X-ray images. This helps the doctor identify any gallstones or obstructions. If a blockage is found, small instruments are used through the endoscope to remove the gallstone or relieve the obstruction. In some cases, the doctor may place a small stent in the duct to keep it open and ensure bile flows properly. Additionally, ERCP can be used to perform biopsies when there is a suspicion of cancer around the pancreas or bile ducts. By taking a small tissue sample from the affected area, the doctor can analyze it to confirm or rule out cancer, providing critical information for diagnosis and treatment planning. This capability makes ERCP an essential tool not only for treating obstructions but also for investigating potential malignancies in the digestive system.

Figure 2. ERCP Procedure

ERCP is highly effective in treating gallstones that have moved into the bile ducts and are causing symptoms. It is especially beneficial because it eliminates the need for traditional surgery, making it a minimally invasive option with a quicker recovery time. Many patients experience relief from their symptoms immediately after the procedure, as the bile ducts are cleared and normal digestion can resume.

ERCP offers several advantages over other treatment options for gallstones, especially for those with symptomatic stones causing blockages. Here are some of the key benefits of ERCP:

Minimally Invasive: Unlike traditional surgery, ERCP does not require any incisions in the abdomen. The endoscope is inserted through the mouth, making it a minimally invasive option with less pain and quicker recovery.
Immediate Symptom Relief: ERCP provides immediate relief for patients experiencing symptoms, as it directly removes the blockage in the bile duct. Many patients report significant improvement in pain and digestive symptoms following the procedure.
Same-Day Procedure: ERCP is often performed on an outpatient basis, meaning that patients can go home the same day. This convenience allows for a faster return to normal activities.
Diagnostic and Therapeutic: ERCP not only identifies blockages but also treats them during the same procedure. This dual function reduces the need for multiple appointments and additional tests.
Reduced Risk of Complications: By using ERCP to clear the bile ducts, patients can avoid complications related to untreated gallstones, such as infections or pancreatitis. This makes ERCP a preventive as well as a therapeutic procedure.

Before undergoing ERCP, patients will need to undergo some preparation to ensure the procedure goes smoothly. Your doctor may recommend that you fast for a few hours before the procedure to keep the digestive system clear and will suggest an ultrasound or MRCP (Magnetic Resonance Cholangiopancreatography). In some cases, blood tests or imaging, such as an ultrasound, may be required to confirm the presence and location of gallstones. During ERCP, patients are usually given mild sedation to keep them comfortable and relaxed.

After the procedure, patients are monitored for a short period before being discharged. Most patients can resume light activities the next day, although strenuous activities may need to be avoided for a few days. Your doctor will provide specific instructions on post-procedure care, including any medications to prevent infection or manage mild discomfort.

At RS Abdi Waluyo, we prioritize patient care and are committed to providing the most advanced treatments for digestive health issues, including gallstones. Our highly skilled internal medicine specialists are experienced in performing ERCP, ensuring that each patient receives expert care tailored to their needs. With state-of-the-art technology and a patient-centered approach, we offer effective, minimally invasive solutions for managing gallstones and other biliary conditions.

Resources