Biliary Stent Placement
Function of Bile and Causes of Bile Duct Obstruction
The function of bile is to aid in the digestion of food, particularly fats. When food enters the intestine from the stomach, bile is discharged into the intestine through the bile duct.
If the function of the bile ducts is impaired due to cancer, autoimmune diseases, or adhesions, it can lead to narrowing or obstruction of the bile ducts, necessitating specific interventions.
Clinical Symptoms and Treatment Methods for Biliary Obstruction
Bile duct obstruction leads to elevated bilirubin levels in the blood, resulting in jaundice, skin itching, and overall a reduced quality of life.
Under these circumstances, by consulting a specialist to address these symptoms (jaundice and obstruction), you may be considered a candidate for surgery, ERCP, or PTC.
Diagnostic Methods in the Evaluation of Biliary Obstruction
The initiation of these treatments requires precise and comprehensive imaging, such as ultrasound, endosonography, MRCP, CT scan, and, in some cases, even biopsy.
Percutaneous biliary drainage (PTC) and metallic stent placement
In cases where ERCP or surgery is unsuccessful, the patient becomes a candidate for percutaneous drainage (PTC).
This procedure can be performed using three methods.
– Internal metallic stent
External drainage of the bile ducts
Internal/External Drainage of Bile Ducts
Intervention Clinics
The interventional clinics at pardis noor comprehensive imaging centers utilize advanced equipment and a specialized team to provide minimally invasive medical treatments with high precision and safety.
Steps for Performing Biliary Stent Placement Under Imaging Guidance
The patient presents with symptoms of biliary obstruction and elevated bilirubin levels. After evaluating imaging studies, coagulation tests, and the location of the obstruction, the patient is deemed a candidate for this procedure. Based on the length of the stricture, an appropriate stent and balloon are selected. In most cases, general anesthesia is not required; however, dilation of the bile duct in cases of severe obstruction necessitates anesthesia. Under ultrasound and fluoroscopic (C-arm) guidance, the dilated bile ducts in the liver are identified. Using an 18-gauge needle, a puncture is made, and specialized guidewires are passed through the stricture. Following this, the narrowed segment is dilated using angioplasty balloons, and stent placement is performed. The patient is monitored for hematoma and bile leakage. Finally, all instruments are removed, leaving only a small incision a few millimeters in size visible on the skin.
Internal Plastic Stent (Internal Stent) and Its Mechanism of Action
Metal stents are fully placed inside the duct, whereas plastic stents resemble a catheter (tube). The initial part of the catheter, which contains several holes, is positioned in the intestine. The middle section of the catheter or stent, also equipped with holes, is placed within the bile ducts and along the length of the stricture. The end portion of the catheter or stent, which remains outside the skin, is connected to a flushing valve and is secured to the skin using sutures and a fixation device. In cases where the cost of a metal stent is prohibitive, this method serves as a highly suitable alternative. The procedure is performed similarly to the placement of a metal stent, with the only difference being the type of stent used. After the procedure, the patient is monitored for hematoma and bile leakage, and a specialized marker is placed on the catheter to ensure it remains in its designated position, maintaining bile drainage to the intestine. With this type of stent, a drainage bag is not routinely attached to the catheter. It is only connected when necessary and with the approval of the treating physician, for a specified duration. This type of stent requires replacement every 3 to 4 months and is completely removed from the body once the obstruction is resolved. Maintaining this catheter is not particularly challenging; however, care must be taken to prevent displacement of the catheter.
External Plastic Stent and the Challenges of Its Maintenance
In cases where it is not possible to bypass the biliary duct stricture, the treating physician places an external plastic stent. This is done under ultrasound and fluoroscopy (C-arm) guidance. Initially, the dilated duct is selected and punctured using an 18-gauge needle. Afterward, the pathway is widened using specialized guidewires and plastic tubes of appropriate sizes (dilators). Finally, an external plastic stent is positioned within the bile duct. This allows bile drainage, but with the distinction that the bile exits the body. A bag is attached to the end of the plastic stent, which extends outside the skin. Maintaining the bag can be somewhat challenging due to the length of the tubing and the bag’s connector, making it difficult to manage. Many patients complain about the maintenance of external stents, as they are secured to the skin with only a few sutures and a fixator. Even minor pulling can dislodge the stent from its designated position, disrupting bile drainage.
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Frequently Asked Questions
In what cases is biliary stenting performed?
This procedure is performed to relieve obstructions in the bile ducts caused by tumors, gallstones, or ductal strictures, allowing the normal flow of bile to the intestines to be restored.
How is stenting performed?
A stent is placed through the skin or endoscopically into the bile duct under imaging guidance (such as fluoroscopy) to keep the obstructed pathway open.
Is hospitalization required after stent placement?
This procedure is typically performed with a short hospital stay, and if the patient’s condition remains stable, discharge is usually completed within 1 to 2 days.