Therapeutic procedure for removing stones, opening blockages, and placing stents in the bile ducts and pancreas
Gallstones in the bile ducts, blockages, or pancreatic tumors are complex medical conditions requiring precise intervention. In the past, treating these conditions required major abdominal surgery.
ERCP (Endoscopic Retrograde Cholangiopancreatography) changes the picture.
This is a combined procedure using endoscopy and X-ray fluoroscopy to reach the bile and pancreatic ducts through the mouth, without external incisions.
Dr. Vosko, Director of the Advanced Endoscopy Unit at Hadassah, is a renowned expert in performing complex ERCP.
Using delicate equipment and high skill, he is able to extract "stuck" stones, open blockages, and insert stents to drain bile, thereby saving the patient from pain, infection, and unnecessary surgeries.
Need urgent treatment or a second opinion? Contact us to coordinate an ERCP with an expert.
Who is this treatment for?
ERCP is a therapeutic procedure (not just diagnostic) intended for patients with a proven problem or high suspicion of a bile duct/pancreas issue.
Key Indications:
- Bile Duct Stones (Choledocholithiasis): Stones that migrated from the gallbladder and blocked the main duct, causing severe pain, jaundice, or inflammation.
- Blockages and Tumors: Releasing blockages caused by pancreatic or bile duct tumors, causing obstructive jaundice.
- Bile Duct Inflammation (Cholangitis): A medical emergency requiring immediate drainage of infected bile.
- Bile Leaks: Treating complications after gallbladder removal surgery (leak from the duct stump).
- Strictures: Dilating scarring narrowings in the bile ducts.
The great advantage is the ability to solve a deep mechanical problem in the abdomen without a surgeon's knife.
ERCP is considered one of the most complex procedures in gastroenterology ("High Stakes Procedure").
- High Volume Experience: Dr. Vosko has performed hundreds of ERCP procedures, including complex cases of large stones or altered anatomy (post-gastric surgery).
- Safety: Use of advanced techniques (such as gentle cannulation and use of pancreatic stents) to minimize the risk of post-procedure pancreatitis.
- Technology: Dr. Vosko works with advanced equipment from Boston Scientific (which he represents as an instructor), allowing laser stone fragmentation (SpyGlass) if necessary.
Life-saving treatment for bile ducts, without surgery.
Dr. Vosko invites you for treatment in safe and experienced hands.
How is the treatment carried out?
How is the consultation conducted?
- Insertion: The patient lies on their stomach or side under deep sedation/anesthesia. A side-viewing endoscope (Duodenoscope) is inserted into the duodenum, to the exit opening of the bile ducts (the Papilla).
- Cannulation: A thin tube is inserted into the Papilla and contrast dye is injected to visualize the ducts on X-ray.
- Incision (Sphincterotomy): Usually, a tiny electrical cut of the Papilla muscle is performed to widen the opening.
- Treatment: Extracting stones using a "balloon" or "basket," or inserting a stent (plastic/metal tube) to drain the bile.
How should I prepare for treatment?
How should I prepare for the consultation?
- Fasting: Full fasting for at least 8 hours.
- Medications: Stopping blood thinners is critical (with medical consultation), as the procedure involves tissue cutting.
- Antibiotics: Sometimes a preventive dose is given before the procedure.
What to expect the day after? (Recovery and recuperation)
- Observation: Usually, one night of hospitalization is required for observation, to ensure there is no abdominal pain or fever.
- Diet: Gradual return to liquids and soft diet the next day.
- Discharge: If everything is normal, discharge takes place the following morning.
Are there risks or side effects?
Despite its efficacy, ERCP carries risks that should be known:
- Pancreatitis: The most common complication (about 3-5%), manifesting as abdominal pain. Dr. Vosko employs a strict prevention protocol.
- Bleeding: From the incision area in the Papilla (usually stopped by endoscopic treatment).
- Infection: In the bile ducts (treated with antibiotics and drainage).
Information for patients from abroad (medical tourism)
The unit is equipped to receive international patients and collaborates with agents for a full logistical envelope.
Direct inquiries are also welcomed for rapid and efficient coordination.
We receive international patients for emergency cases of obstructive jaundice or complex elective treatments (such as removing giant stones), with rapid coordination with private hospitals.
For your convenience, Dr. Vosko is fluent in Hebrew, English, and Russian.
How long is the hospital stay?
Unlike gallbladder surgery, hospitalization after ERCP is very brief. In most cases, only one night of observation is needed to ensure there are no complications, with discharge home the following morning.
Is it permissible to eat fats after the removal of stones from the biliary tract?
After the stones have been removed, the passage is open, but it is recommended to maintain a low-fat diet during the first two weeks so as not to overload the digestive system and pancreas, which are still recovering from the irritation.
What are the signs of pancreatitis after the procedure?
The most common (though still rare) complication is pancreatitis. If you experience severe abdominal pain radiating to the back, persistent vomiting, or a high fever within one to two days after the procedure, you should seek immediate medical attention at the emergency room.
A stent (tube) was left inside me. Does it need to be removed?
It depends on the type of stent. Plastic stents should be removed after a few weeks or months in a brief follow-up procedure. Certain metallic stents remain permanently. Dr. Vosko will clearly specify in the discharge report when you need to return for stent removal.
Is ERCP considered a surgery?
Technically, no, because there are no incisions and everything is performed through the mouth. In practice, this is a complex procedure, equivalent to surgery in terms of the required skill and medical considerations. Therefore, careful preparation and monitoring, similar to those for surgery, are required.
We are with you - from the very first call, we understand that on the other end of the line is a person who may be concerned or in pain, waiting for answers. Therefore, we have built a service system that truly sees you:
- High Availability: A live service center is active Sunday-Thursday from 09:00 AM to 07:00 PM and on Fridays from 09:00 AM to 02:00 PM. In urgent cases, we are available beyond these hours.
- Direct WhatsApp Line: Do you have a question about fasting? Did you forget to ask something about your medications? Our customer service is available via WhatsApp for a quick response.
- Peace of Mind from Bureaucracy: Our team is highly experienced in working with insurance companies and supplemental health plans. We will assist you in preparing the necessary paperwork and authorizations so that you can focus entirely on your health.
ERCP - Endoscopy of the Bile and Pancreatic Ducts
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