What is biliary stent placement?

A biliary (say "BILL-ee-air-ee") stent, also known as a bile duct stent, is a thin, hollow tube that is placed in the bile duct. The stent holds the duct open after the duct has been blocked or partly blocked.

Fluids like bile need to flow through your bile duct into your intestine to help digestion. If the duct is blocked, these fluids can build up in the liver. This can cause symptoms such as jaundice (yellowing of your skin and whites of your eyes), belly pain, and nausea. Bile that isn't draining as it should can get infected.

Opening up the duct with a stent allows bile to drain and can help you feel better.

There are two ways your doctor can place a bile duct stent: ERCP and PTC.

ERCP (endoscopic retrograde cholangiopancreatography)

In an ERCP, the doctor will use a tool called an endoscope, or scope. It is a thin, lighted tube that bends. It has a camera on it that lets the doctor use pictures on a screen to guide it. The doctor uses the scope to put a metal or plastic tube in the bile duct. This can help open the duct.

Before the test, you may get medicine to numb the back of your throat. You also will get medicine to help you relax.

PTC (percutaneous transhepatic cholangiography)

In a PTC, the doctor moves a long needle through your belly and into the liver. The needle is used to inject dye into the liver. X-rays are taken while the dye moves through the bile ducts. The doctor will take that needle out and insert a special hollow needle into the bile duct. The doctor will then move the stent through this needle and place it in the bile duct.

You will get medicine to numb your skin and keep you comfortable during the test. During the test, you will lie on your back. At some point you may be asked to roll to your side.

Activity

• Rest as much as you need to after you go home.
• You should be able to go back to your usual activities within a day or two, depending on how physically hard those activities are.

Diet

• Follow your doctor's directions for eating after the procedure.
• Drink plenty of fluids (unless your doctor tells you not to).

Medicines

• Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
• If you take aspirin or some other blood thinner, be sure to talk to your doctor. He or she will tell you if and when to start taking this medicine again. Make sure that you understand exactly what your doctor wants you to do.

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

In this procedure, a biliary (say "BILL-ee-air-ee") stent is placed in the bile duct. The stent holds the duct open after the duct has been blocked or partly blocked. The stent is a thin, hollow tube. It is also known as a bile duct stent.

You will be given instructions about recovering from your procedure. They will cover things like diet, wound care, follow-up care, driving, and getting back to your normal routine.

After an endoscopic retrograde cholangiopancreatography (ERCP), you may have a sore throat for a day or two.

Most people feel better after stent placement. Some people need to have this procedure repeated because the stent gets clogged.

Endoscopic retrograde cholangiopancreatogram (ERCP)

If your biliary duct placement was done with ERCP, you probably will stay at the hospital or clinic for 1 to 2 hours. This will allow the numbing medicine to wear off. You will be able to go home after your doctor or a nurse checks to make sure that you are not having any problems. If you stay in the hospital overnight, you may go home the next day.

You may have a sore throat for a day or two after the procedure.

Percutaneous transhepatic cholangiography (PTC)

If the placement was done with PTC, your doctor may have you lie on your right side for at least 6 hours before you can go home. This is to lower the risk of bleeding from the injection site.

If you stay in the hospital overnight, you may go home the next day.

You may have some pain where the needle entered your skin (the puncture site). You may also have pain in your shoulder. This is called referred pain. It's caused by pain traveling along a nerve that goes to the liver. The referred pain usually lasts less than 12 hours. You may have a small amount of bleeding from the puncture site.

You will need to take it easy at home for 1 or 2 days after the PTC. You will probably be able to go back to work and most of your usual activities after that.

Placing a stent in the bile duct helps the bile flow when the duct is damaged or blocked. This can happen during surgery or because of scar tissue or a tumor.

Fluids like bile need to flow through your bile duct into your intestine to help digestion. If the duct is blocked, these fluids can build up in the liver. This can cause symptoms such as jaundice (yellowing of your skin and the whites of your eyes), belly pain, and nausea. Bile that isn't draining as it should can get infected.

Opening up the duct with a stent allows bile to drain and can help you feel better.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be canceled. If your doctor told you to take your medicines on the day of the procedure, take them with only a sip of water.
• Take a bath or shower before you come in for your procedure. Do not apply lotions, perfumes, deodorants, or nail polish.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• You may get medicine that relaxes you or puts you in a light sleep. The area being worked on will be numb.
• Tell your doctor if you are allergic to iodine. It is in the dye that the doctor puts into the bile ducts.
• For an ERCP, the doctor may send puffs of air through the tube to see better. This may make you feel bloated.
• You may feel some bloating or cramping as the ERCP tube is moved. If you are very uncomfortable, you can let the doctor know with a signal or a tap on the arm. You and your doctor can agree on this signal before the test.
• After an ERCP, you will stay at the hospital or clinic for 1 to 2 hours until the numbing medicine wears off.
• After a PTC, you will lie on your right side for about 6 hours. This is to lower the risk of bleeding from the injection site. After that, you can most likely go home.

There are two ways your doctor can place a bile duct stent.

Endoscopic retrograde cholangiopancreatography (ERCP).

This is the most common method. The doctor feeds a thin, lighted tube gently down your throat, through your stomach, and into the bile duct. The doctor moves the stent down the tube and into the bile duct. The tube has a camera on it. It lets the doctor see exactly where to place the stent.

Percutaneous transhepatic cholangiography (PTC).

First the doctor moves a long needle through your belly and into the liver. The needle is used to inject dye into the liver. With the help of X-rays, the dye shows the doctor where the bile duct blockage is. Then a special hollow needle is inserted. The doctor moves the stent through this needle to place it in the bile duct.