A biliary stent is a plastic or metal tube that is inserted into a bile duct to relieve narrowing of the duct (also called bile duct stricture).
Biliary stenting is used to treat obstructions that occur in the bile ducts. Bile is a substance that helps to digest fats and is produced by the liver, secreted through the bile ducts, and stored in the gallbladder. It is released into the small intestine after a fat-containing meal has been eaten. The release of bile is controlled by a muscle called the sphincter of Oddi found at the junction of the bile ducts and the small intestine.
There are a number of conditions, malignant or benign, that can cause strictures of the bile duct. Pancreatic cancer is the most common malignant cause, followed by cancers of the gallbladder, bile duct, liver, and large intestine. Noncancerous causes of bile duct stricture include:
The overall incidence of bile duct stricture is not known. Approximately 0.2–0.5% of patients undergoing gallbladder surgery or other operations affecting the bile duct develop biliary stricture.
A biliary stent is a thin, tube-like structure that is used to support a narrowed part of the bile duct and prevent the reformation of the stricture. Stents may be made of plastic or metal. The two most common methods that are used to place a biliary stent are endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC).
ERCP is an imaging technique used to diagnose diseases of the pancreas, liver, gallbladder, and bile ducts that also has the advantage of being used as a therapeutic device. The endoscope (a thin, lighted, hollow tube attached to a viewing screen) is inserted into a patient's mouth, down the esophagus, through the stomach, and into the upper part of the small intestine, until it reaches the spot where the bile ducts empty. At this point a small tube called a cannula is inserted through the endoscope and used to inject a contrast dye into the ducts; the term retrograde refers to the backward direction of the dye. A series of x rays are then taken as the dye moves through the ducts.
If the x rays show that a biliary stricture exists, a stent may be placed into a duct to relieve the obstruction. In order to do this, special instruments are inserted into the endoscope and a sphincterotomy (a cut into the sphincter of Oddi) is performed to provide access to the bile ducts. In some cases, the biliary stricture may first be dilated (expanded) using a thin, flexible tube called a catheter, followed by a balloon-type device that is inflated. The stent is then inserted into the bile duct.
PTC is similar to ERCP in that the test is used to diagnose and treat obstructions affecting the flow of bile from the liver to the gastrointestinal tract. The procedure is generally reserved for patients who have undergone unsuccessful ERCP. A thin needle is used to inject a contrast dye through the skin and into the liver or gallbladder; x rays are taken while the dye moves through the bile ducts. If a biliary stricture becomes evident, a stent may then be placed. A hollow needle is introduced into the bile duct, and a thin guide wire inserted into the needle. The wire is guided to the area of obstruction; the stent is advanced over the wire and placed in the obstructed duct.
Prior to ERCP or PTC, the patient will be instructed to refrain from eating or drinking for at least six hours to ensure that the stomach and upper part of the intestine are free of food. The physician should be notified as to what medications the patient takes and if the patient has an allergy to iodine, which is found in the contrast dye. Antibiotics will be started prior to surgery and continued for several days afterward.
After the procedure, the patient is monitored for signs of complications. In the case of ERCP, the patient generally remains at the hospital or outpatient facility until the effects of the sedative wear off and to ensure no complications occur. After PTC, the patient is instructed to lie on his or her right side for at least six hours to reduce the risk of bleeding from the injection site. To ensure that the stent is functioning properly, the patient will be frequently assessed for symptoms that indicate the recurrence of biliary stricture. These symptoms include changes in stool or urine color, jaundice (yellowing of the skin), itching, and abnormal liver function tests .
Complications associated with ERCP include excessive bleeding, infection, pancreatitis, cholangitis (inflammation of the bile ducts), cholecystitis (inflammation of the gallbladder), and injury to the intestine. PTC may result in bleeding, infection of the injection site, sepsis (spread of infection to the blood), or leakage of the dye into the abdomen. Complications specific to the stent include migration (movement of the stent out of the area in which it was placed), occlusion (blockage), and intestinal perforation.
In more than 90% of patients, the placement of a biliary stent relieves the obstruction and allows the bile duct to drain properly.
The rate of serious complications with ERCP is approximately 11%, and 5–10% with PTC. Stent occlusion occurs in up to 25% of patients, and stent migration in up to 6%. Recurrence of biliary stricture occurs in 15–45% of patients after an average time of four to nine years.
The major alternative to biliary stenting is surgical repair of the stricture. The most common method is resection (removal) of the narrowed area followed by the creation of a connection between the bile duct and the middle portion of the small intestine (called a choledochojejunostomy) or the hepatic duct and the small intestine (called a hepaticojejunostomy). Surgical stricture repair results in a cure for 85–98% of patients and is associated with a low risk of complications.
Feldman, Mark, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 7th ed. Philadelphia: Elsevier Science, 2002.
American Gastroenterological Association. 7910 Woodmont Ave., 7th Floor, Bethesda, MD 20814. (301) 654–2055. http://www.gastro.org .
American Society for Gastrointestinal Endoscopy. 1520 Kensington Rd., Suite 202, Oak Brook, IL 60523. (630) 573–0600. http://www.asge.org .
Society of Interventional Radiology. 10201 Lee Highway, Suite 500, Fairfax, VA 22030. (800) 488–7284. http://www.sirweb.org .
Pande, Hemant, Parviz Nikoomanesh, and Lawrence Cheskin. "Bile Duct Strictures." eMedicine. June 3, 2002 [cited May 1, 2003]. http://www.emedicine.com/med/topic3425.htm .
Yakshe, Paul. "Biliary Disease." eMedicine. March 29, 2002 [cited April 7, 2003]. http://www.emedicine.com/MED/topic225.htm .
Stephanie Dionne Sherk
Biliary stenting is usually performed in the xray department of a hospital or outpatient facility in consultation with a general surgeon, a gastroenterologist (a medical doctor who specializes in the diagnosis and treatment of diseases of the digestive system), and/or an interventional radiologist (a medical doctor who specializes in the treatment of medical disorders using specialized imaging techniques).
Pancrease head - normal fine
tail - normal
What could it be, they said it has already spread and they cannot help me anymore. They said so surgery or chemotherapy can help and i should get peace with my relatives as i dont have long to live. This was done at a Hospital South Africa. I am Zimbabwean
40 yrs ago. Now they have discovered a small tumor that is pressing on my bile ducts also a type of ovarian cancer.
They want to put a stent in my bile duct, to help the slight
jaundice I have., and possibly treat me with chemo. What do you think.
Please what will be the next step.As doctor told us that metallic stent is last for life and would not block.Anyhow can this stent be reopen or new it require new stent or any other treatment will require??????
I am still having some abdominal pain ,eyes and skin still have the yellow tint.
My question is how long does it take for the pain and jaundice to go away?
I have been experiencing a lot of what seems like spasms in that area. (upper right quad) they don't last but a second, but they are very very intense pain. Pain meds do not touch it. Went back to hospital on emergency they said bloodwork & x-ray was ok. What could be causing these awful pains?
He cannot tolerate general anesthesia due to lung problems - it is all so confusing - please help
Thank you for your time.
Amber
with the diagnostics i am having Hepatities B Jaundice, in MRCP TEST Mid CBD stricture and gal bladdar stone. In MRCP informed no blockage . doctor suggested for ERCP.
Please advise me for next course of action.
please reply as soon as possible.
above this i am suffering,DIABITIC,HYPERTENTION,JUNDICE.
I recently had an ERCP. I had a stent placed in my common bile duct during last year Christmas Eve and was told by the doctor to return to remove it on 29 January 2012 but I start feeling pain on New Eve and was admitted but the doctor told me the pain is not due to the stent is should be the food I ate and I was discharge. Subsequently I was admitted again on 22 January 2012 due serious abdominal pain. This time the doctor discover that the stent had given way and they need to do the CT scan, x ray & ultra sound to find it. The doctor that perform the ERCP on 25 January 2012 manage to take out the stone from my liver but he told me he can't reach out for the stent and I was told by him that he may have to cut me to take it out. On 26 January 2012 4am they send me to take a x ray to confirm the stent where about but can't find the stent and the doctor told that the stent would have pass out. I'm ready concern can the stent be pass out?
Also us there anyone who has had a similar experience...
Any help would be appreciated...
Presumably it was felt I needed this stent, so guessing a replacement will be suggested via a 4th ERCP. Should I request surgical correction? After all, knowing that I passed 1 stent, what would prevent it happening again?
a whole week of unbearable pain and vomiting after food i ate,i had the op they took the stones out
and put a stent in the duct to stop more stone going in I have to go back to have my gallbladder out
within the next 3 months and then 2 weeks after i have to go back in to have another op to
remove the stent from my bile duck but my question is should i still have discomfort pain in the tummy
and how long will it last for ? I had this done 2 days ago i came home with no pain killers or antibiotics
but was told i nnly get them if i was actually cut inside and what pain killers would u suggest to take ?
Thankyou
2.During stenting how stones are remove..??
Paritosh Saha
B.A.M.S Student
why can't the stent remain in if there's no problem.
I am still having some abdominal pain ,eyes and skin still have the yellow tint.
My question is how long does it take for the pain and jaundice to go away?
The doctors are now saying that ai should have my bile duct rerouted to my small intestine, surgically.
Is this the wisest thing to do? I have no gallblader.
Since having the stent put in I have frequent diahrhea.
I am a 74 year old female who was in good health prior to this.
how long can the plastic biliary stents stay in the common bile duct?
She returned to the hospital after picking up a virus and also to be told her bile duct was a leaking and after being given a bag to drain away the fluid had a small procedure to have a stent placed in her body.She is very very weak and and fluid still collects in the bags 8 days after the stent being placed ..Please , she would like to know if this should still be happening ?
Hi I am a 53 year old lady - can anyone tell me how long a metal stent can remain in the bile duct?
Mine has been in for 5 month. I had a complex gallbladder removal and a perforated bile duct that was stitched up. I have varices and had an internal bleed. I am due to have it removed in a couple of weeks and am really scared in case something goes wrong. I have already suffered acute Pancreatitis from an ERCP.
Many Thanks for replies.
my jaundice is going well but I'm tired of pain. before ERCP+stent I had 21 chemotherapy, I have pancreatic cancer.
Is the pain normal or I should be worried?
From all these posts I believe this ERCP procedure is risky and have heard of warning of these devices being contaminated and causing possible infections in patients. My mother passed away 1 day after her 87 bday. My family will be persuading any legal recourse we have available to us. The FDA has now admitted that these devices may have design flaws that do not allow the scope to be sanitized effectively and as a result can cause a serious infection in patients who undergo an ERCP. We all are guinea pigs in the eye of the medical industry.
Goggle "FDA ERCP" and get educated.
My name is Nobert Mukupa, I have a Grandmother aged 82yrs and she was being investigated for obstruction of Jaundice, secondary to Gall bladder stone in the vatin ampulla. She has been referred for ERCP + Sphincterotomy procedure. This procedure is not found in all our hospitals here in Zambia. Kindly help me to know how much this procedure cost in total.
My brother in-law is 48 yrs. old. He had two biliary drainage catheters put in a week ago to relieve his high bilirrubin. He was responding well to the chemo for his liver ca. but his stents needed to be changed and the dr.'s waited too long to address this (he lives in colombia).He has been told by the interventional radiologists that there's nothing to do while his oncologist says the contrary. How long is it safe to have these catheters? Can someone live withe these external catheters in place? Any information you can provide would be greatly appreciated.
so kindly please suggest me that it is serious problem or not.
thankyou for giving your precious time
Now latly i am having a hard time pooping, i have to take a laxitive, and the other day the first part was white and the rest was watery, and a lot i went to the toilet 5-7 times that day, i have had some pain when it gets like that and a little bit of blood
Doing fine, now having a funny noise in stomach & slight discomfort top left side of stomach!! Has a stint come loose & how would I know ??
Few days later an endoscopy carried out and a stent inserted.
I'm home now one week, drain pipe removed and a bag stuck on.
Now I'm feeling terrible pain in the abdomen like if I were to stretch it would cause damage, I feel quite vulnerable, is this the stent causing this ? If so when it's removed in a few weeks will that pain go. Any advice
Three days later I had a ERCP to put in a stent in order to stop the drain but after 6 weeks the drain instead to be less and less it was increasing so they did one more ercp with two stent but the drainage is now increasing much more then before the surgen suggested to put a still stent
Because the plastic stent can leak
Now I worry so much because I think they are not doing the job right
This is in done in the Vancouver general hospital
Is anyone that have any experience to be able to give me any suggestions what a should do ?
I thank you very much in advance for any advice
Valentino
personally i think its somewere in his small intestine .. i dont believe the doctor checked any other place then were it was originally placed over a year ago..