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Biliary stenting

Definition
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).

Purpose
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 fatcontaining 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:

injury to the bile ducts during surgery for gallbladder removal (accounting for 80% of nonmalignant strictures) pancreatitis (inflammation of the pancreas) primary sclerosing cholangitis (an inflammation of the bile ducts that may cause pain, jaundice, itching, or other symptoms)

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Stents may be made of plastic or metal. until it reaches the spot where the bile ducts empty. tube-like structure that is used to support a narrowed part of the bile duct and prevent the reformation of the stricture. special instruments are inserted into the . and into the upper part of the small intestine. hollow tube attached to a viewing screen) is inserted into a patient's mouth. Approximately 0.   gallstones radiation therapy blunt trauma to the abdomen Demographics The overall incidence of bile duct stricture is not known. At this point a small tube called a cannula is inserted through the endoscope and used to inject a contrast dye into the ducts.2–0. and bile ducts that also has the advantage of being used as a therapeutic device. gallbladder. through the stomach. down the esophagus. ERCP ERCP is an imaging technique used to diagnose diseases of the pancreas. The endoscope (a thin. A series of x rays are then taken as the dye moves through the ducts. Description A biliary stent is a thin. a stent may be placed into a duct to relieve the obstruction.5% of patients undergoing gallbladder surgery or other operations affecting the bile duct develop biliary stricture. If the x rays show that a biliary stricture exists. lighted. liver. the term retrograde refers to the backward direction of the dye. The two most common methods that are used to place a biliary stent are endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC). In order to do this.

the stent is advanced over the wire and placed in the obstructed duct. followed by a balloon-type device that is inflated. The wire is guided to the area of obstruction. the patient is monitored for signs of complications. Aftercare After the procedure. the patient generally remains at the hospital or outpatient facility until the effects of the sedative wear off and to ensure no complications occur. In some cases. If a biliary stricture becomes evident.endoscope and a sphincterotomy (a cut into the sphincter of Oddi) is performed to provide access to the bile ducts. A hollow needle is introduced into the bile duct. 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. Diagnosis/Preparation Prior to ERCP or PTC. After PTC. x rays are taken while the dye moves through the bile ducts. PTC 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. and a thin guide wire inserted into the needle. In the case of ERCP. a stent may then be placed. The physician should be notified as to what medications the patient takes and if the patient has an allergy to iodine.Antibiotics will be started prior to surgery and continued for several days afterward. the patient is . which is found in the contrast dye. flexible tube called a catheter. The procedure is generally reserved for patients who have undergone unsuccessful ERCP. the biliary stricture may first be dilated (expanded) using a thin. A thin needle is used to inject a contrast dye through the skin and into the liver or gallbladder. The stent is then inserted into the bile duct.

To ensure that the stent is functioning properly. Morbidity and mortality rates The rate of serious complications with ERCP is approximately 11%.instructed to lie on his or her right side for at least six hours to reduce the risk of bleeding from the injection site. and 5–10% with PTC. Normal results In more than 90% of patients. . Complications specific to the stent include migration (movement of the stent out of the area in which it was placed). occlusion (blockage). itching. These symptoms include changes in stool or urine color. the patient will be frequently assessed for symptoms that indicate the recurrence of biliary stricture. and intestinal perforation. PTC may result in bleeding. Stent occlusion occurs in up to 25% of patients. and stent migration in up to 6%. cholecystitis (inflammation of the gallbladder). and abnormal liver function tests . cholangitis (inflammation of the bile ducts). sepsis (spread of infection to the blood). Recurrence of biliary stricture occurs in 15–45% of patients after an average time of four to nine years. jaundice (yellowing of the skin). the placement of a biliary stent relieves the obstruction and allows the bile duct to drain properly. and injury to the intestine. Risks Complications associated with ERCP include excessive bleeding. infection. infection of the injection site. or leakage of the dye into the abdomen. pancreatitis.

1520 Kensington Rd. 10201 Lee Highway.. http://www. IL 60523. (630) 573–0600. Resources BOOKS Feldman.Alternatives The major alternative to biliary stenting is surgical repair of the stricture. (800) 488–7284. VA 22030. 2003]. Mark. 7th ed. Suite 500. 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). MD 20814.asge. "Bile Duct Strictures.org . Oak Brook. Philadelphia: Elsevier Science. Suite 202.org . American Society for Gastrointestinal Endoscopy. Sleisenger & Fordtran's Gastrointestinal and Liver Disease.sirweb. and Lawrence Cheskin. ORGANIZATIONS American Gastroenterological Association. http://www. 7910 Woodmont Ave.. Fairfax. OTHER Pande. (301) 654–2055.org . et al.gastro. http://www. Bethesda. Surgical stricture repair results in a cure for 85–98% of patients and is associated with a low risk of complications. 7th Floor. Hemant.emedicine. http://www. June 3. 2002 [cited May 1. 2002. Parviz Nikoomanesh. .com/med/topic3425." eMedicine.htm . Society of Interventional Radiology.

com/A-Ce/BiliaryStenting.emedicine.surgeryencyclopedia. 2003]. "Biliary Disease.Yakshe.com/MED/topic225." eMedicine. Stephanie Dionne Sherk Read more: http://www.htm . March 29. http://www. Paul. 2002 [cited April 7.html#ixzz2OKCBY5k2 .