ABOUT | WHO CAN WE HELP? | SERVICES | OUR SPECIALISTS | CASE STUDIES | REFERRALS

A DEDICATED SERVICE
FOR HEPATOBILIARY AND
PANCREATIC DISEASES

PANCREAS
LIVER
GALL BLADDER
PANCREATIC TRACT

Who we can help?

Patients with:

  • Abnormal liver enzymes
  • Jaundice
  • Liver mass or suspected cancer
  • Diseases of the gall bladder and bile duct
  • Biliary stone related diseases
  • Pancreatic mass or cystic lesion
  • Pancreatitis
  • Family history of pancreas cancer or pancreatitis
  • Enlarged lymph nodes in upperabdomen or ches

RETURN TO TOP

What is EUS?

EUS: Endoscopic Ultrasound

When is it recommended?

Important in the work up of these common problems:

  • Painless jaundice, suspecting pancreatico-bilary cancers
  • Cystic lesion in the pancreas
  • Portal or intra-abdominal lymphadenopathy/mass
  • Oesophageal and gastric cancer
  • Lung cancer or mediastinal lymphadenopathy/mass
  • Sub-mucosal lesion in the GI tract
  • Panceatitis

Uncommon indications

  • Microlithiasis
  • Sphincter of Oddi Dysfunction (typer 2 & 3)
  • Screen and surveillance for pancreatic cancer
  • Suspected pseudo-achalasia
  • Assessment of thickened gastric wall or linitis plastic

RETURN TO TOP

What is ERCP?

ERCP: Endoscopic Retrograde Cholangio-pancreatogram

Common problems

• Gall stones in the bile duct
• Malignant bile duct obstruction
• Bile duct leak post cholecystectomy

Uncommon problems

• Benign bile duct obstructions
• Sphincter of Oddi Dysfunction (type 1 & 2)
• Pancreatic duct stones and obstructions
• Paancreatic pseudocysts

RETURN TO TOP

THE HEPATOBILIARY SPECIALIST CENTRE

This Specialist Centre located at North Eastern Community Hospital in Adelaide, is dedicated to provide care for patients with diseases of the pancreas, gall bladder, liver and biliary tract. It is the first of its kind in the north-eastern region of South Australia.

The Hepatobiliary Specialist Centre has been established by specialist gastroenterologist, Dr Nam Nguyen.

Together with our state-of-the-art endoscopic unit, including Endoscopic Ultrasound (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP) and the upgraded surgical high dependency care, this service is able to provide a “one-stop-shop” assessment and treatment for most hepatobiliary diseases.

RETURN TO TOP

Who can we help?

Patients with:

  • Abnormal liver enzymes
  • Jaundice
  • Liver mass or suspected cancer
  • Diseases of the gall bladder and bile duct
  • Biliary stone related diseases
  • Pancreatic mass or cystic lesion
  • Pancreatitis
  • Family history of pancreas cancer or pancreatitis
  • Enlarged lymph nodes in upperabdomen or chest

RETURN TO TOP

Our Services

  • General gastroenterology
  • General surgery
  • Bowel cancer screening program
  • Gastroscopy / Colonoscopy / Enteroscopy
  • Endoscopic ultrasound and interventions
  • ERCP and interventions
  • Therapeutic procedures
  • Iron Infusions

Endoscopic Therapeutic Procedures

  • Oesophageal dilatation
  • Polypectomy
  • Argon Plasma Coagulation
  • Endoscopic ultrasound and related interventions
  • Endoscopic mucosal resection of polyps and early mucosal tumours
  • ERCP and interventions including :
    • Endoscopic Sphincterotomy – CBD stone removal
    • Biliary or Pancreatic stent insertion
    • Biliary or Pancreatic stricture dilation

RETURN TO TOP

Our Specialists

Dr NAM NGUYEN
Dr Nguyen is the Senior Consultant Gastroenterologist at the Royal Adelaide Hospital, and a Senior Clinical Lecturer at the University of Adelaide. He is an Interventional Endoscopist, who had spent two dedicated years of fellowship in United States to train in advanced endoscopy and management of hepatobiliary disorders. He was one of the first EUS Endoscopists in South Australia and is exceedingly competent with both diagnostic and therapeutic endoscopic procedures. These complimentary skills enable him to reach the diagnosis as well as providing treatment at this centre in a short time frame.

At a research level, he is actively involved in a number of national and international projects that aims to advance our understanding in the genetics of pancreatic cancer and treatment. He also facilitates the screening program for subjects who are at risk of pancreatic disease – one of our deadliest cancers.

 

RETURN TO TOP

Case Studies

Case 1 – Pancreatic cancer

Obstructive liver function test with dilated biliary tract on US

  • 49 years old man
  • Non-specific abdominal pain for the last 2 months
  • Dark urine but no jaundice
  • Minimal weight loss
  • Screening LFT showed normal bilirubin but ALP/GGT > 5x of normal
  • Abdominal US showed dilated proximal CBD to 11mm.
  • No mass seen on CT scan.

ERCP:

  • Short stricture (1cm) in mid?CBD
  • A short plastic stent was inserted
  • Patient felt better
Endoscopic ultrasound evaluation:

  • A ~2cm mass in the head/neck region of pancreas
  • Mass was not involved any vascular structure
  • No locally lymphadenopathy, and no metastasis on imaging
  • Staging based on CT and EUS imaging: T2N0M0
  • FNA confirmed invasive carcinoma of the pancreas
Surgical resection

  • Whipple’s procedure within 2 weeks of diagnosis
  • Uneventful post-operative recovery
  • Adjuvant chemotherapy
  • Still well after 18 months

Case 2 – Cholangiocarcinoma

Obstructive jaundice with dilated biliary tract

  • 62 years old man
  • Painless jaundice for 2 weeks
  • 5 kg weight loss over 12 months
  • Lethargic and loss of appetite
  • Pruritus is the main symptoms

LFT:

  • Bilirubin 189, ALP 1222, GGT 1400 CT scan (below):
  • Dilated intra- and extra-hepatic ducts
  • No obvious mass or stone

Endoscopic ultrasound examination on the same session of ERCP and biliary stenting

EUS showed a 1.8cm mass arised in the proximal CBD, suggestive of cholangiocarcinoma, with local staging of T1N0

  • No metastatic disease on imaging
  • EUS FNA (through the duodenum) confirmed the diagnosis

Subsequent surgical resection

Whipple’s procedure after 2 weeks of dignosis

  • Proximal cholangiocarcinoma
  • Recovered well
  • Disease free of 24 month

Case 3 – Pancreatic pseudocyst

Abdominal pain with previous attacks of pancreatitis

  • 45 years old woman
  • Known heavy alcohol drinker
  • Previous attacks of pancreatitis
  • No presented with dull epigastric pain with severe nausea/vomitting
  • Poor appetite and lost 5 kg over 2 weeks Normal amylase and lipase CT scan (below):
  • large cyst mass in the body/tail of pancreas, consistent with a pancreatic pseudocyst
  • No biliary dilatation or stone

EUS guided pseudocyst drainage

EUS evaluation:

  • To determine size, wall thickness, degree of ‘liquification’ for drainage procedure

Pseudocyst drainage procedure under fluoroscopyre

Balloon dilatation of cystgastrostomy track under direct endoscopic vision

Case 4 – CBD stone for extraction

  • · 85 years old woman
  • · Recent attacks of RUQ pain
  • · Obstructive LFT
  • · Dilated biliary tract with stones on US
  • · ERCP:
  • · Multiple stones in the CBD
  • · Successfully extracted after sphincterotomy and basket trawl

Case 5 – Wrong labelled ‘Chronic pancreatitis’

Episodic RUQ pain with no history of pancreatitis

  • 49 years old woman
  • Known severe fibromyalgia
  • On opioid for 12 yrs
  • 6-month history of ‘new’ episodic RUQ
  • pain, lasting from 1-3days
  • No symptoms of pancreatic insufficiency
  • No ETOH or history of pancreatitis
  • Normal amylase and lipase, but
  • faecal elastase was low
  • CT scan (below):
  • normal appearing pancreas
  • No biliary dilatation or stone

Normal pancreas:

  • No atrophy
  • No calcification
  • No ductal abnormality

Opinion from a surgical specialist:

  • Abdominal pain from chronic pancreatitis
  • Needs to be on opioids for life

Second opinion!…for EUS examination

Diagnosis

  • Biliary colic from biliary stone and microlithiasis
  • No pancreatits

Pain resolved after stone removal and cholecystectomy

Case 6 – Liver lesion after colonic cancer

Liver lesion found after resection of a sigmoid

  • Colonic carcinoma
  • 43 years old man
  • Known Merkel cell tumour, treated with radiotherapy and was in remission
  • Surveillance PET scan showed a possible lesion.
  • No liver lesion
  • Colonoscopy showed a sigmoid cancer

Management of a single metastatic liver lesion from previous colonic carcinoma

Surveillance CT scan 6 months post-operatively:

  • An enlarging liver lesion suspicious of metastasis
  • Chemotherapy
  • Resection
  • Disease -free at 6 month follow-up

RETURN TO TOP

Referrals

Referral is simple!

  • Utilise your existing referral system on your software and fax to 8365 1139
  • Call North Eastern Community Hospital on 8366 8111 for an appointment.

RETURN TO TOP

Take a look for yourself

Contact Details

Hospital

Address:
580 Lower North East Road Campbelltown SA 5074

Phone: (08) 8366 8111
Fax: (08) 8365 1139
Email: exec@nech.com.au

Aged Care

Address:
Cnr Lennox Street & 580 Lower North East Road Campbelltown SA 5074

Phone: (08)8366 8111 Ext 338
Fax: (08) 8366 8260
Email: exec@nech.com.au

Contact Us