HPB Diagnostic and Treatment Service

Endoscopic ultrasound (EUS) is a highly accurate test that allows doctors to see the pancreas, bile ducts and surrounding organs in great detail from inside the body. A thin, flexible camera with an ultrasound probe on the tip is passed gently through the mouth into the stomach and small intestine.

From this position, the ultrasound can create very detailed images of the pancreas, lymph nodes and bile ducts. If needed, we can also take small tissue samples (biopsies) during the same procedure to help reach a precise diagnosis.

EUS is commonly used to look for bile duct stones or investigate pancreatic cysts or masses, unexplained jaundice, abnormal scans, and to stage cancers. It is usually done as a day-case procedure with sedation, and you can go home the same day.

ERCP is a specialised procedure that allows doctors to see and treat the bile ducts and pancreatic ducts from inside the body. A thin, flexible camera is passed gently through the mouth into the stomach and small intestine, reaching the ducts that carry bile and pancreatic fluid.
ERCP can be used to remove stones, relieve blockages with stents and take small tissue samples.

You might need an ERCP if you have:

• bile duct stones
• jaundice
• a narrowing of the bile duct
  
• a narrowing of the pancreatic duct
• stones in the pancreatic duct

We perform over 600 ERCP procedures every year as the tertiary specialist referral hub of North West London. We are equipped with the latest technology to handle difficult and complex cases that other centres may not be able to treat.

Cholangioscopy is a cutting-edge endoscopic procedure that allows doctors to look directly inside the bile ducts using a tiny high-resolution camera. Unlike ERCP, which relies on X-ray imaging, cholangioscopy provides real-time, detailed views of the duct lining.

This advanced technique is used to identify strictures, remove difficult stones, take targeted tissue samples, and guide precise treatment. It is usually performed under general anaesthesia, often in combination with ERCP, allowing both diagnosis and treatment to be completed safely in a single visit.

You might need cholangioscopy if:

• you were diagnosed with a large bile duct stone
• you previously had ERCP procedures which were not able to clear your bile ducts from stones
• you have an indeterminate bile duct stricture requiring a targeted biopsy

Therapeutic EUS is a cutting-edge, minimally invasive approach that allows our team to treat complex pancreaticobiliary and digestive conditions without surgery. Using a high-resolution endoscopic ultrasound probe, we can access and internally treat areas that previously required open operations or areas requiring access from the skin.

Common advanced procedures include:

• EUS-guided biliary drainage (EUS-BD) – to relieve blocked bile ducts and jaundice if ERCP fails or if ERCP is not feasible.
• EUS-guided gallbladder drainage (EUS-GBD) – as a non-surgical alternative for gallbladder drainage if you have acute cholecystitis and you are not a candidate for gallbladder surgery.
• EUS-guided gastrojejunostomy (EUS-GJ)– to bypass an obstructed bowel segment whether the obstruction is due to a cancer or and inflammatory disease such as chronic pancreatitis. This procedure will allow you to resume a normal diet and recover quickly.
• EUS directed transgastric ERCP (EDGE) – if you had a previous bariatric surgery (bypass) and you need an ERCP for various reasons such as bile duct stones or bile duct blockage.
• EUS-guided cystgastrostomy – to drain pancreatic cysts or fluid collections resulting from a previous episode of pancreatitis.

Endoscopic ampullectomy is a minimally invasive, cutting-edge procedure used to remove growths or early tumours at the ampulla - the area where the bile duct and pancreatic duct meet in the small intestine.

Using a specialised endoscope, the growth is carefully removed without the need for open surgery. This allows precise treatment with faster recovery, reduced risk and shorter hospital stay.