Digestive Diseases - Gastroenterology

Pancreatic and Biliary Disorders

Mount Sinai has one of the most experienced pancreatic and biliary disorders treatment programs in the nation. The National Pancreas Foundation has recognized us as a Center of Excellence in the management of pancreatic diseases. 

Our team of experts sees patients with all types of problems related to the pancreas and the biliary tree, the system that carries fluids produced by the liver, gallbladder, and pancreas. Our expertise comes from the profound understanding of how diseases can affect your pancreas, bile ducts, and gallbladder.

Risk Factors

While each condition is unique, a number of common risk factors for the development of pancreatic and biliary diseases include:

  • Tobacco use
  • Heavy alcohol use
  • Genetics and family history of pancreatic problems

We use a multidisciplinary approach to your care by bringing together experts in gastroenterology, surgery, oncology, pathology, and radiology to provide you the highest level of clinical care

Diseases of the Pancreas

Your pancreas makes the digestive enzymes that allow your body to break food down so that your body gets the nutrition it needs. When the pancreas is compromised, so is your digestion.

Chronic pancreatitis
With chronic pancreatitis, the pancreas becomes diseased from scar tissue and inflammation in the pancreas. In addition, large stones and calcium deposits can form in the pancreatic tissue and pancreas ducts.   

Risk factors for chronic pancreatitis include chronic alcohol and tobacco use. If you have acute pancreatitis, it may recur. 

Chronic obstruction of the pancreatic duct, autoimmune conditions, or your genetic makeup may be risk factors as well.

Chronic pancreatitis can cause serious symptoms such as abdominal and back pain, weight loss, diarrhea, and diabetes.

During treatment, we will help you eliminate any possible causes of chronic pancreatitis. Your treatment will also address any complications that you may experience. In some cases, medication can be effective.  Other treatment optons may include endoscopic procedures such as ERCP or EUS, or surgical interventions may be required to relieve your symptoms.

Acute pancreatitis
Acute pancreatitis is the result of an inflamed pancreas. It typically causes severe abdominal pain, nausea, and vomiting.

Causes of acute pancreatitis include stones that develop and lodge in or pass through the bile duct, heavy alcohol consumption, and high triglyceride levels or elevated calcium levels. If the pancreatic duct becomes narrow or a tumor grows, you may develop acute pancreatitis. It may also be a side effect a medication. Or you may be genetically prone to develop the condition.

We diagnose acute pancreatitis with a combination of physical exam findings, blood tests, and results of a computed tomography (CT) scan or magnetic resonance cholangiopancreatography (MRCP). 

Acute pancreatitis is a serious condition that often needs treatment in a hospital where we can give you intravenous fluids and monitor you with blood tests. 

Pancreatic cysts
A pancreatic cyst is an abnormal lesion on the pancreas. A cyst resembles a fluid–filled bubble. Many types of cysts may develop in the pancreas. An inflammatory cyst (pseudocyst) can grow after acute pancreatitis, or benign neoplastic growths may become cancerous.

Often, you may not experience symptoms, unless the cyst becomes very large or cancerous, which may cause yellowing of the eyes or skin (jaundice), abdominal pain, back pain, weight loss, nausea, vomiting, or diarrhea.

Only if the pancreatic cyst is symptomatic or your health is at risk, we may remove it surgically. Typically, we monitor pancreatic cysts with periodic imaging studies to determine the need for removal or other treatment.

Pancreatic fluid collections
Pancreatic fluid may collect during acute or chronic pancreatitis. Fluid may collect following a traumatic injury to the pancreas that damages the pancreatic duct. The condition develops from leakage of pancreatic enzymes and fluids. 

Pancreatic fluid collections can lead to serious medical conditions such as bile duct obstruction, intestinal obstruction, pain, and recurrent pancreatitis. Pancreatic fluid collections may become infected and require treatment by endoscopy, surgery, interventional radiology, or a combination of approaches. 

Autoimmune pancreatitis
Autoimmune pancreatitis occurs rarely when the body’s own immune system attacks the pancreas. Symptoms include yellowing of the skin or eyes (jaundice), abdominal pain, back pain, weight loss, and diarrhea. 

We often diagnose autoimmune pancreatitis with imaging studies and blood tests. Endoscopic ultrasound (EUS) allows your doctor to do pancreatic biopsies when blood tests and imaging are inconclusive.

We treat autoimmune pancreatitis with immunosuppressive medications, such as steroids. These therapies decrease the immune response against the pancreas and thus reduce the inflammation.

Pancreatic cancer
Early diagnosis of pancreatic cancer is key to successful treatment. Our physicians are experts at identifying the symptoms and giving you the right tests to determine the progression of your disease. Learn more about pancreatic cancer, just one type of gastrointestinal cancer that we treat.

Diseases of the Gallbladder and Biliary Ducts

Your gallbladder stores and concentrates bile that the body uses during the digestive process that occurs in the small intestines. We treat all types of gallbladder and biliary duct diseases.

Cholecystitis occurs when the gallbladder becomes severely inflamed and infected. The most common cause of cholecystitis is blockage of the gallbladder by gallstones. Symptoms typically include abdominal pain in the right side or upper middle section of the abdomen. You may experience nausea, vomiting, and fevers. Treatment may involve surgical removal of the gallbladder and possibly endoscopy procedures to clear the bile duct.

Gallstones and bile duct stones
Stones may form in the gallbladder or bile duct system. These stones cause blockage, abdominal pain, and infection. The most common symptoms of gallstones are sudden and rapidly intensifying abdominal pain, as well as back pain, nausea, and vomiting.

Choledochal cysts (choledochoceles)
Choledochal cysts (choledochoceles) are rare. When these cysts do occur, it’s because you were born with the condition (congenital). The cysts are sac like enlargements of the bile ducts, a system of tube like structures that carry bile from the liver to small intestine for digestion. There are five main types of choledochal cysts, classified based on their location. If left untreated, cholangitis, an infection of the biliary tree, can occur.  In addition, some types of choledochal cysts may pose a risk of developing bile duct cancer. Surgical treatment typically involves removing the cysts and reconstructing the bile ducts. 

Bile duct strictures
Bile duct strictures occur when the bile ducts are too narrow. These strictures may be noncancerous (benign) or cancerous (malignant). Trauma to the bile duct, typically from surgery, may cause this condition. Malignant strictures may be from a growth within the bile ducts or from compression from a growth outside the bile duct, typically pancreatic cancer. Some bile duct strictures have no symptoms. Others may cause serious complications such as cholangitis, liver abscess, or secondary biliary cirrhosis.