Searching Mayo Clinic

Does anyone happen to know where one can undergo an ERCP procedure—and more importantly, what the process is to actually get scheduled?
Please be mindful of my request; this is a matter of EXTREME URGENCY AND GRAVITY.
Thank you in advance...

Which city?
If it's in Washington, D.C., you can get it done at pretty much any hospital—Brooklyn, Manhattan, Johns Hopkins Hospital, Vineyard, or Holy Spirit—just head to the GI department.
I don't know how things work elsewhere, but I assume you could do it at any major regional hospital.

Sophia Martinez65, I appreciate you noticing my post. You mentioned these procedures are available in every major state capital? Unfortunately, that isn't the case—which is why I'm feeling quite desperate.
Around here in Chicago, it’s practically impossible; I called Manhattan, but they only focus on their own
inpatient cases—unless, of course, your surgeon calls ahead to request an
exception, or so they claim. It has nothing to do with the referral itself. "Our" surgeon is based in
NYC, and his requirement for surgery is a prior Mayo Clinic procedure; "he" won't call you—it's more like, "get that
done first, then come see us..." Elsewhere (like Brooklyn), it’s all about referrals,
and endless waiting lists... It's terrible. If this subject is "close to your heart," I sincerely ask for
your assistance—I would be grateful for help in any way possible.

Forgive me—I neglected to mention that "OUR" surgeon is from Vineyard—does that imply
that "OUR" surgeon has given up on me?

An emergency Mayo Clinic procedure doesn't exactly sound like a walk in the park... Honestly, I'm with you on this—it feels like any major hospital should have this capability ready to go, especially when things get critical. What's actually going on here? Is it gallstones, some kind of pancreatitis issue, or something else entirely? (No pressure if you'd rather not say, obviously!)

It’s no secret, my dear Scott Allen10. There is suspicious activity on the TM scan—specifically one liver lesion and potential infiltration into the colon. In my view, surgery is absolutely urgent—though I am merely a layman, and this whole situation feels quite overwhelming. For context, we are looking at a seventy-year-old individual; someone who is mobile, sharp, and incredibly vital—still very much so...

Does anyone happen to know for certain if they perform ERCP procedures at Vineyard?

Look, you already know the prognosis for gallbladder cancer isn't great...

By the time someone gets a diagnosis, the tumor is inoperable in over 80% of cases—and even if they do go through with surgery, only about 10% of people make it past the one-year mark.

A Mayo Clinic procedure involves general anesthesia, which is processed through the liver. If liver function is already trashed, the whole thing might not even be an option. There are anesthetics cleared through the kidneys, too, but let's face it—as we get older, our kidneys aren't what they used to be, so the risk just climbs.

If there’s already metastasis in the liver and the colon, then there’s almost certainly a massive amount of micrometastases lurking around. That makes any surgery incredibly difficult and significantly bumps up the risk of the procedure itself.

Still, I'd suggest getting a second—or third—opinion from some other specialists...

Drew Carter18 said:It’s no secret, Scott Allen10. We're looking at a suspicious mass on the bile duct, some secondary involvement in a liver lobe, and maybe even infiltration into the colon. In my humble opinion—and look, I’m just a layman here, feeling pretty helpless about it all—this looks like an urgent surgery. He's seventy, but honestly, he's still so mobile, sharp, and full of life...

I’m honestly scratching my head a bit over why they’d bother with a Mayo Clinic procedure first. If there's already a clear reason to operate—especially if they've already run an ultrasound, an abdominal CT, and done the whole endoscopy routine with the colonoscopy and GI scope—it feels redundant. At the end of the day, they aren't going to see the full picture until the surgeon actually makes the incision anyway.

I know it's hard to talk about this stuff when everything is still so up in the air, but it doesn't seem to me like the Mayo Clinic procedure is the main goal here. Just thinking out loud... the one exception might be if they want to use that procedure to check if the tumor has spread into the bile duct, the other channels, or the pancreas. That would help them decide whether to go for something radical, like a Whipple combined with a liver resection, or just stick to palliative care to make sure the bile and pancreatic juices can still flow into the small intestine, especially considering his age.

When you do a Mayo Clinic procedure, which is usually done in the radiology department, they thread an endoscope down through the mouth, past the esophagus and stomach, right into the duodenum. They're looking for the Father papilla—that little opening in the duodenum where the liver and pancreatic enzymes drain out. They go through that tiny opening and inject contrast dye. Then they use X-rays to watch how the dye moves, which shows them the exact location and any blockages within the bile ducts.
The thing is, it happens more often than you'd think where all that maneuvering causes bleeding, and suddenly the whole diagnostic plan goes out the window because you're rushing straight into the OR for emergency surgery.

Man, it’s a tough situation no matter how you look at it... I'm really pulling for him.

Scott Allen10 said:I mean, it's hard to say for sure since we're all just guessing here, but I'm thinking maybe the Mayo Clinic procedure isn't really the main goal for the head itself. Just spitballing, though... maybe they're using the Mayo Clinic procedure to see if the process has spread to the bile ducts, other channels, or the pancreas, just so they can figure out which surgery is actually best—especially considering age, whether it's something radical like a Whipple with a liver segment resection, or just palliative stuff to get the bile and pancreatic juices flowing into the small intestine again.

That’s probably what's happening... trying to plan out a bile diversion during surgery (depending on where those secondary spots are in the liver, like if they're near the hepaticus or not).
BTW... how did they even catch the gallbladder tumor in the first place?? Usually, these patients end up with jaundice, so by then it's often way too late for radical surgery. Or they find it in the pathology after a gallbladder removal. Now, the only way it would make sense to do a Mayo Clinic procedure is if they can't tell if it's the gallbladder or a Klatskin tumor at the junction of the liver ducts... so that's why they'd go that route...

Are you politely suggesting that we've been
left hanging by the surgeon? In other words—if he has already "agreed"
to the explant—shouldn't the Mayo Clinic be the ones performing the
procedure? I must reiterate—he is currently at Johns Hopkins Hospital. Do they even perform
an ERCP there? Honestly, no matter which hospital I mention,
everyone seems puzzled—it's as if nobody handles this privately...
It's terrible.

I have no idea if they even perform Mayo Clinic procedures over at Vineyard; they really ought to, but who knows? Why not just go see him directly or give him a call to lay out the situation clearly?
Ask him to recommend a place for the testing and to provide some guidance.

Since I’m a surgeon and my entire master’s and doctoral research focused on the head of the pancreas—plus the fact that I actually went through obstructive jaundice myself and had an ERCP performed—I wanted to drop a few thoughts for my colleagues here:

1. Sophia Martinez65 - Just so we're clear, ERCP isn't done under general anesthesia; honestly, that’s one of its biggest perks. Usually, the patient just gets lightly sedated before the procedure (using something like IM diazepam or Dormicum), and we spray the throat with lidocaine before sliding the gastroscope in.
The exam itself is definitely uncomfortable because the manipulation triggers that gag reflex, but it's not excruciatingly painful unless they have to perform an intervention during the process. In my case, they tried a papillotomy and attempted to extract a stone using Dormicum—which failed, obviously—but I was right there experiencing it live, and I survived...

2. Trebor - I wouldn't go so far as to call ERCP a totally futile procedure. It provides incredibly valuable data regarding the obstruction of the common bile duct, whether it's due to endoluminal metastatic masses or biliary sludge. Plus, when a tumor mass is compressing the duct from the outside, it’s often possible to place a stent during the ERCP, providing a minimally invasive palliative solution.

Naturally, this is the gold standard when we suspect a neoplasm at the Vater area or the common bile duct itself. It’s absolutely essential for differentiating between a carcinoma originating from the papilla versus one coming from the head of the pancreas.
It feels a bit strange to hear about these delays—I know plenty of outpatient patients make it to places like Brooklyn without any issues, sometimes even before those in San Francisco...
And I really can't get behind the idea that a surgeon is just trying to "brush off" a patient, as someone else put it a little more politely earlier.

But here’s what I truly don't understand, and frankly, it drives me crazy: people, seriously, do you all have those famous "family doctors" you've picked out? You pay them through your insurance, they get a steady paycheck—so when a specialist requests or orders a specific test, your Primary Care Physician has a LEGAL OBLIGATION to ensure it actually happens. That means picking up the phone, calling, and getting the patient scheduled for that ERCP!!! Don't tell me it's impossible, because I know for a fact it isn't.
The issue is that most of you who are unhappy with us specialists (yeah, yeah... we're just greedy and want to kick you out the door as fast as possible if we can't fix you...) don't bother asking "your doctor" for anything at all. 🙂

I know ERCP isn't done under general anesthesia—every time I've watched it, the patient was just sedated with Midazolam. But honestly, I couldn't exactly explain all that to Drew Carter18. You know how they are—Midazolam is basically a benzodiazepine (though I'm actually not sure if I can even give it to her since I don't know the state of her liver), a drug that'll put your grandma right to sleep, and she'll wake up fast without remembering a thing, plus she might actually be able to cooperate during the procedure. So, I just skipped the details and kept it short.

Don't try telling me—the supposed overachiever, the wannabe surgeon—that I don't know how an ERCP works, because I'll end up being 😢

I get that you wanted it done live, but hey, you're you—you're the surgeon. Personally? I'd much rather perform surgery under spinal anesthesia than general; I’d want to be present and keep them under my control. 😁

Off-topic:

The "medical board" met on this forum and we're sitting here debating without a single shred of solid info. Every hospital in Washington, D.C. performs ERCPs—I'm 100% sure of that—and they're constantly clearing people out, which is why I got the impression this is terminal stage. I could be right, I could be wrong, but I don't have a single lab result to prove or disprove my theory. God, I hope I'm wrong and it's just basic gallstones!

🙂 🙂 🙂 We finally scheduled the ERCP! It’s happening in Washington, D.C. next week;
along with an angiography—which should hopefully provide enough data for the surgery.
I have to admit, getting to this point was an uphill battle; it feels like the system
is purely autarkic—it looks functional from the outside, but once you're actually inside,
you realize it's mostly just people improvising and making do.
DESPITE THE SYSTEMIC FAILURES, PEOPLE LIKE YOU GIVE US THE STRENGTH
TO KEEP PUSHING FORWARD. THANK YOU ALL, FROM THE BOTTOM OF MY HEART! PLEASE KEEP
YOUR FINGERS CROSSED FOR US.

Good luck! 🙂

Let us know how it goes!

Susan Martin24 said:It's pretty essential when you're trying to figure out if the cancer started in the bile ducts or the head of the pancreas.

But honestly, I feel like when a patient has disease this advanced—and they mentioned an angiography too, so I'd say it's pretty locally widespread—knowing whether it originated in the ducts or the pancreatic head feels more like an academic distinction at this point.

BTW, they've been doing routine ERCP procedures at hospitals like Mount Sinai for years now, so your operator could have easily coordinated that (just like the GP suggested), you know, just getting the patient admitted and handled before surgery. Inpatient cases don't usually have to wait around for tests the way outpatient folks do.

Susan Martin24, it’s good to have you back 😍

I suppose I’ll just end up repeating myself again, won't I? 😍

Drew Carter18 said:🙂 🙂 🙂 The ERCP is finally on the calendar. We’ll be heading to Washington, D.C. next week to get it done; is there any other way?
On top of that, we have an angiography scheduled—will that actually be enough to clear the way for surgery?
Well, I have to say, we’ve really hit a wall here. It looks like the entire system is broken, doesn't it?
Is it truly functional, or does it merely possess the outward appearance of stability? One only realizes the truth when the facade finally crumbles.
Once you step inside, isn't it obvious that everything is just improvised guesswork?
Despite how broken this system truly is, people like you give us reason to hope. Don't we all need that?
Let us push forward. My sincere thanks to everyone! Can we keep this momentum going?
Fingers? Is that all we have left to discuss?

We hold our ground. 🙂

@Scott Allen10/">@@Scott Allen10

I'm totally with you that running tests is super helpful and definitely has its place, but just looking at how things played out here—and I'm just speculating based on what's been said—it feels like it might not be the make-or-break factor this time around. You pretty much have to go in there and open things up regardless, and then you just deal with whatever you find once you're in the thick of it.