Chapter 1453 ERBD and PTCD

Chapter 1453: 1453 ERBD and PTCD

"From the current scans, the patient’s bile duct shows a significant mass, which does not rule out the possibility of bile duct cancer."

After the patient lay down beside him, Su Wenhao whispered to the patient’s wife.

Upon hearing his words, the patient’s wife’s face suddenly changed.

Even if she doesn’t understand this disease, the word "cancer" alone is enough to tell her what’s going on.

"However, you shouldn’t rush to conclusions. At the moment, we’re just not ruling out this possibility; further examinations are needed," Su Wenhao continued.

"Doctor, then... what kind of tests do we need to do?" the patient’s wife asked.

"Don’t worry yet, I need to call in an expert for a consultation," Su Wenhao said.

"Okay, doctor, we’ll wait for your news," the patient’s wife hurriedly responded.

For her now, she was already in a state of confusion, and she also needed time to process this information.

"Teacher Liu, do you think we should proceed with an MRI and marker screening next?" Su Wenhao leaned towards Liu Banxia.

"That’s something to consider; can you think of anything else?" Liu Banxia asked.

"I think we need to drain the patient’s bile to alleviate their symptoms," Su Wenhao said.

"Alright, let’s start with magnetic resonance cholangiopancreatography. As for the drainage, don’t discuss specific procedures with the patient’s family until the MRI results are out," Liu Banxia considered for a moment and said.

"Okay."

Su Wenhao responded and quickly went to notify the patient’s family.

Liu Banxia leaned towards the computer, carefully examining the patient’s CT scans.

Even though he’s not a radiologist, the mass is indeed quite obvious.

"Teacher Liu, do you think the possibility is high?" At this moment, Su Wenhao also returned.

"I think the possibility is quite high; how’s the patient doing?" Liu Banxia asked.

"Not very well; he might have guessed something. Was it wrong of me to send the patient away earlier instead of finding another opportunity to communicate with his family?" Su Wenhao asked.

"You handled it very well; you didn’t directly tell the patient it might be bile duct cancer, which was commendable," Liu Banxia said.

"For many patients, when they hear they might have a terminal illness, their mental state collapses, which offers absolutely no benefit for their condition."

"When we’re explaining the illness, unless the patient explicitly asks and doesn’t need family to assist, that’s when you can make preliminary disclosures to the patient."

"I’ve treated several cancer patients, all at different stages. For some, I chose to approach indirectly; for others, I chose to be direct."

"For instance, a previous case of esophageal cancer, telling him might have been a huge blow. But he was already in the late stages; how many days did he have left to live?"

"Telling him, he could eat some of the foods he usually wouldn’t indulge in, fulfilling some regrets in this world."

"But this patient is different; he came with his family. And he’s not very old, so informing them about the condition requires more caution."

"Moreover, what you should consider now is recommending a drainage method to the patient’s family since his bile retention is already quite severe, posing a risk of shock without drainage."

Su Wenhao nodded, still feeling a bit frustrated.

The current drainage methods are endoscopic retrograde bile duct drainage, ERBD for short, and percutaneous hepatic puncture drainage, PTCD for short.

The key issue? He’s not familiar with either of these drainage methods.

How should he recommend them to the patient’s family?

There’s no choice; he has to study and understand these two drainage methods thoroughly first.

"Teacher Liu, do you perform ERBD via ERCP with ease?" Su Wenhao hesitated slightly before asking.

"I’ve seen it done twice; if you choose to do this, I personally recommend consulting Shi Lei," Liu Banxia said.

"As for PTCD, I can do it. The rest is up to you to decide; that shouldn’t be a problem, right?"

"Thank you, Teacher Liu," Su Wenhao replied with a smile.

The performers for these drainage methods are settled; now it’s time to discuss with the patient’s family. Much depends on the family’s choice, as his role as a doctor is mainly to recommend.

But it’s not that simple; the procedures need to be explained clearly to the patient and their family to help them make informed choices.

Liu Banxia took another look around and, seeing nothing else demanding his attention, shifted his focus back to this patient.

This patient’s condition is indeed quite severe.

After waiting for a while, the MRI scan results were also available.

Similar to the CT scans, the mass is apparent, and bile duct cancer cannot be ruled out.

"Doctor, just tell me the truth; do I have a serious illness?"

The returning patient asked.

"Don’t overthink it; we’re still in the examination phase," Su Wenhao said.

"My wife is crying quietly; would she react this way for a common disease?" the patient asked.

"Before a definitive diagnosis, all judgments are speculative," Su Wenhao explained.

"But now we have another issue to address, which is the bile in your duct. It’s excessive at the moment, which could lead to further complications."

"Such as increasing your abdominal pain and fever, potentially leading to shock. This is what we need to focus on right now, isn’t it?"

"Doctor, what medicine should he take?" the patient’s wife asked.

"Simply taking medication is no longer enough to relieve his symptoms," Su Wenhao said.

"So we’re recommending two approaches. First, endoscopic retrograde bile duct drainage. The procedure involves using an endoscope through the mouth, inserting a tube at a point in the duodenum, and injecting contrast agent."

"We can then assess the situation inside the bile duct and directly drain the bile, which is less invasive."

"Recovery time is short, and discharge is quick. However, there could be complications, though this method is frequently chosen by patients."

"The second option is percutaneous hepatic puncture drainage. This method is straightforward to understand, where we directly puncture the abdomen and remove the bile from the duct."

"Doctor, which of these surgeries is better?" the patient’s wife asked.

"It’s hard to say; both surgeries have their pros and cons. The first one is non-invasive, but the endoscope extends majorly, about one meter or possibly more," Su Wenhao said.

"The latter is invasive, but its path is shorter, roughly around twenty centimeters. Once the path is established, patients usually feel no different during subsequent treatments."

"ERCP’s route is different, the non-invasive method I mentioned. Every time we need drainage, it requires re-operation."

"However, the latter has limitations, unlike ERCP’s route with various operative methods. Both have pros and cons, with some differences in costs."

"Given his current situation, our suggestion is hospitalization for anti-inflammatory and drainage treatments, though this approach tends to be conservative. We believe it’s necessary."

This is a subtle hint, even if the patient asked earlier, it’s mainly for the family to explain to the patient.

"Doctor, should we get hospitalized first and then consider things? Can we make it in time?" the patient’s wife asked.

"It’ll be on time; you also need to stabilize your emotions to make a more appropriate decision. Feel free to come to me with any questions," Su Wenhao patiently said.

The patient’s wife nodded and helped the patient with the procedures.

"Teacher Liu, do you think the patient already knows?" Su Wenhao asked.

"Probably, he might have some idea," Liu Banxia said.

"Often, our concealment from patients isn’t truly hiding. It’s because they don’t want to believe it, so they pretend not to know."

"Sometimes there’s really no way to conceal such illnesses. Especially as more examinations are conducted, thoughts and suspicions increase."

"Teacher Liu, if the patient asks me again later, how should I respond?" Su Wenhao asked.

"You’ll have to judge individually; if the patient is mentally strong enough, you can choose to explain it clearly to him," Liu Banxia said.

"Well... I’ll drop it, this patient is clearly incapable," Su Wenhao sighed.

Even though the patient just asked voluntarily, it doesn’t mean he can handle the news.

Otherwise, the follow-up inquiries wouldn’t primarily be from the family, with the patient staying silent.

And now there’s another issue: although the mass is apparent, it’s only "not excluded," with no definitive diagnosis yet.

Now he understands why Liu Banxia emphasized addressing the bile issue as the top priority.

Whether it’s bile duct cancer needs careful assessment, but the bile situation is indeed perilous.

But as for himself, his mind is preoccupied with bile duct cancer.

It seems he needs to strive more, learn more about ERBD and PTCD.

The patient and family are completely uninformed; after completing procedures, they would still question him. He needs to duly explain with responsibility.