Whangarei Hospital is now able to offer a form of advanced endoscopy procedure for patients to help relieve obstruction in the ducts connecting the gallbladder and liver with the bowel, saving patient trips to Auckland. Bile obstruction could be due to stones, at times cancer and patients can get very sick unless urgent intervention undertaken. This surgery, known as endoscopic retrograde cholangiopancreatography (ERCP), is performed using a thin flexible camera tube that is inserted through the mouth. Patients are usually kept relaxed following administration of sedative medications.
Historically, patients were referred for ERCP at hospitals in Auckland. This was expensive and upsetting to some patients and whānau. However, months of careful planning, with support from local DHB clinical and management teams, saw gastroenterologist Dr Arjun Sugumaran lead the first ERCP procedure at Whangarei Hospital on January 16. The patient was 84 year old James Tetuhi of Te Kopuru, who had a mineral stone which was blocking his bile duct treated. All this was achieved in around 20-30 minutes, following which James recovered quickly enough to be sent home the next day.
ERCP is a life-saving procedure but comes with risks. A significant amount of preparation and nursing staff training went into the establishment of the service, including guidance from endoscopy manufacturer Olympus. Arjun has previously been trained in and performed ERCP procedures in the United Kingdom and at Middlemore Hospital. He worked with surgical colleague William Crisp on the first Whangarei procedure.
Arjun said the impact of being able to deliver ERCP treatment within Northland is extremely significant for the whānau of patients, enabling patients to be sent home sooner, cut travel time, costs and eliminate the stress of travel. “It’s also about the family wanting to be with the patient.”
“It’s a permanent setup now and we will cater for up to three patients every week. There was a lot of discussion with Auckland about how to manage the repatriation and we are happy it’s happening now.”
The first patient, 84 year old Jim Te Tuhi, shared his story from home in Te Kopuru, where he is healing slowly but steadily.
Jim said he endured six months of sickness before he was finally taken to hospital. Stones were quickly detected in Jim’s bile duct that needed removal. Before the ERCP procedure the preceding day, Jim was given guidance on how to breathe while the tube was inside him and said the team of Auckland and Whangarei clinicians followed the information which came with the endoscope very closely. The procedure to move the stone out of Jim’s bile duct was completed within an hour.
“The doctors said to me ‘You’re a celebrity, this has never been done!’” Jim recalled. Jim had a successful seven days in hospital and today reports no pain. Jim said he appreciates not having to travel to Auckland for the ERCP procedure, especially since his mum died of gallstones at age 56. Jim returned to the hospital recently to give machine operator Bronwyn Upton a gift of a putiputi (flower) made of pingao, thanking her for her caring 20 minute explanation of the MRI scan procedure on the first day.
Jim thanked his wife Margaret and daughter Esmeralda for their support, as well as “Dr Arjun and his team in their flowing colours and smiles and their encouragement.
“The hospital did so much for me in this instance… The pharmacist Mr Christian talked to me also that they would stand by me should I throw a wobbly. All those staff that assisted me in my days in Ward 4 should be complimented. I am the last male of the first generation of Te Tuhi and I do have my sister 76, support here in Dargaville. Te Ihi Tito the visiting Kaumātua021471133 at the hospital had given me the confidence in his visits not only to me but to others whist I was there. Kia ora, Te Ihi.”
PHOTO – Patient James (Jim) Te Tuhi undergoes the first ERCP in Northland on January 16 2018. Pictured are Dr Arjun Sugumaran (right) with Dr William Crisp (left).