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Tribhuvan University Teaching Hospital may have been the first hospital to start ERCP service nearly 15 years ago. Helped by a Japanese Doctor and three interested Nepalese doctor, we provided investigative and therapeutic ERCP by doing spincterectomy and CBD stone removal. Since then, the Endoscopy Unit has been continuously providing this service (mostly free because our patient cannot afford even the subsidized rate we charge), sometimes with the generous help from doctors from abroad who donated accessories like cannulas, spincterotomes and baskets.
Biliary disease is one of the most common surgical disease in Nepal. Most of the surgeries are usually for obstructive jaundice due to stones and malignancies. There are 4 ERCP sets in Kathmandu to our knowledge. T. U. Teaching Hospital has the most number of endoscopist doing ERCP and because of the steady service and affordable price compared to private setup, we have probably done the highest number of cases. Also, among the few who do therapeutic ERCP, we must have done the most because of the same reason. This, despite the fact, we do not have a therapeutic ERCP set and thus, cannot do stenting, which has become so important because of the increased incidence of malignant inoperable obstruction of the biliary ducts.
MRCP is yet to come in Nepal and till then, ERCP must be used to investigate the biliary disease and there is no substitute for therapeutic procedures. Thus, if we were to have a Therapeutic ERCP set, we would be able to help so many of our people who still travel abroad for management, which we could have given here at much lower price.
Dr. Mahesh Khakurel
Tribhuvan University Teaching Hospital
mkhakurel
healthnet.org.np
15 October 2004
For more information, see A therapeutic video duodenoscope with a large forceps channel or contact ANMF.