Royal Free Pancreatobiliary (PB) Medicine Service
The Royal Free Pancreatobiliary Medicine department provides a patient-centred and comprehensive advanced endoscopy service for a wide array of disorders of the pancreas and biliary tree, along with other gastrointestinal conditions. The unit undertakes over 1,200 pancreatobiliary endoscopies each year, primarily endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). This includes a large proportion of highly complex procedures not offered in other units, including cholangioscopy and the full range of novel interventional EUS procedures. These are mainly under X-ray guidance and an increasing proportion of cases are performed with anaesthetic support. As the regional tertiary referral centre for HPB surgery and liver transplantation, we provide crucial support for these services, as well as the referring hospitals across the region. An inpatient ‘treat and transfer’ service is provided for patients requiring procedures who are admitted in other hospitals. Hence you may be brought to the Royal Free for the day to undergo a procedure which your local hospital is not able to provide.
Aside from advanced interventional endoscopy, PB Medicine clinics run weekly in our outpatient department.
The PB team adopt a multi-disciplinary approach to patient care and work closely with numerous specialist colleagues including hepatopancreatobiliary and transplant surgeons, dedicated HPB interventional radiologists, oncologists and clinical nurse specialists. Some highly specialised procedures are undertaken as combined interventions with these teams, including rendezvous procedures, percutaneous cholangioscopy and laparoscopic assisted ERCP.
The multidisciplinary team convenes weekly at the Royal Free Benign HPB Meeting to guide the treatment of patients with complex non-cancer HPB conditions. This forum provides highly specialist input, typically discussing 30-40 patients each week, and links to the sister PB medicine service at University College London Hospital (UCLH). The team also attend the weekly Royal Free Malignant HPB MDT Meeting to provide input for patients with suspected malignant conditions. We receive referrals for both meetings from centres across North Central London and the wider region. The service is led by hepatobiliary endoscopists with dual roles as transplant hepatologists and who are uniquely placed to provide input for patients with advanced liver disease secondary to biliary disorders (such as PSC) and those post liver transplantation.
PB Endoscopy Services Offered
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Endoscopic retrograde cholangiopancreatography (ERCP)
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Endoscopic ultrasound (EUS)
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Cholangioscopy/SpyGlass
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Electrohydraulic lithotripsy (EHL)
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Pancreatic ERCP/pancreatoscopy
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Pancreatic cystogastrostomy
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Lumen apposing metal stent insertion (LAMS) for internal drainage of pancreatic or other collections
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EUS-guided biliary drainage
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EUS-guided gastro-enterostomy
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Enteric stenting
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Coeliac axis nerve block