Biliary Stenting

What is Biliary Stenting?

Biliary stenting is a medical procedure used to open up blocked bile ducts. The bile ducts are tubes that carry bile from the liver (where it's produced) to the gallbladder (where it's stored) and then into the small intestine (where it aids digestion).

Various conditions, such as gallstones, infections, inflammation, tumours or strictures (abnormal narrowing), can block these ducts. This can cause symptoms like jaundice, abdominal pain, and fever.

Who is Suitable for Biliary Stenting?

Biliary stenting is typically performed for individuals who have:

• Bile duct obstructions: These can be caused by various conditions, including gallstones, inflammation, or tumours. Biliary stenting can help restore the flow of bile.
• Malignancies: In cases where a tumour is causing the blockage, a stent can be inserted to keep the bile duct open. This is often done for palliative care, especially when the tumour cannot be surgically removed.
• Strictures of the bile duct: This refers to the abnormal narrowing of the bile duct, which can block bile flow. Biliary stenting can help open up these strictures.
• Bile leaks: If bile leaks due to a tear or hole in the bile duct, a stent can be placed to close the leak.

Benefits of Biliary Stenting

• Symptom Relief: By reopening blocked bile ducts, biliary stenting can help alleviate symptoms like jaundice, itchy skin, abdominal pain, nausea, vomiting, and fever.
• Improved Liver Function: By restoring bile flow, biliary stenting can improve liver function and digestion.
• Preparation for Surgery: In cases where surgery is needed to treat the underlying condition causing the blockage, biliary stenting can help stabilise the patient and improve liver function before surgery.
• Palliative Care: For patients with advanced cancer that cannot be surgically removed, biliary stenting can provide significant symptom relief and improve quality of life.

Types of Biliary Stents

There are two main types of stents used in biliary stenting:

• Plastic stents: These are typically used for short-term treatment, as they can become blocked over time. They are often used in cases where the obstruction is expected to be temporary or a temporary measure before surgery.
• Metal stents: These are often used for long-term treatment, as they are less likely to become blocked. They are often used for palliative care in cases of malignant obstruction, where the goal is to relieve symptoms and improve quality of life.

Alternative Options to Biliary Stenting

The alternatives to biliary stenting largely depend on the cause of the blockage. These may include:

• Surgery: If resectable tumours or gallstones cause the blockage, surgery might be an option. This could involve removing the gallbladder (cholecystectomy), part of the liver, or a section of the bile duct.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure combines upper gastrointestinal endoscopy and X-rays to treat problems of the bile and pancreatic ducts. It can remove gallstones or other obstructions from the bile duct.
• Percutaneous Transhepatic Cholangiography (PTC): This is a procedure where a thin needle is inserted through the skin and liver into the bile ducts to drain the bile.
• Radiotherapy or Chemotherapy: In cancer cases, these treatments may shrink tumours and relieve blockage.

What to do Before a Biliary Stenting? 

Before undergoing biliary stenting, there are several things that patients typically need to do:

• Medical History Review and Examination: The doctor will review the patient's medical history and conduct a physical examination to ensure they are healthy enough for the procedure.
• Lab Tests: Blood tests may assess the patient's liver function and clotting times.
• Imaging Studies: Ultrasound, CT scan, or MRI may be done to visualise the bile ducts and determine the location and extent of the blockage.
• Fasting: The patient is typically asked to fast (no food or drink) for several hours before the procedure to ensure the stomach and duodenum are empty.
• Medication Management: The patient should inform the doctor about their current medications. Certain medications (such as blood thinners) may need to be stopped or adjusted before the procedure.

Biliary Stenting Procedure

Biliary stenting is typically done during a procedure known as endoscopic retrograde cholangiopancreatography (ERCP). Here's a general overview of what happens:

• Sedation: The patient is given a sedative to help them relax and reduce discomfort.
• Endoscopy: A thin, flexible tube (endoscope) is passed through the patient's mouth, down the oesophagus and stomach, and into the beginning of the small intestine (duodenum).
• Accessing the Bile Ducts: A smaller tube is passed through the endoscope into the bile ducts.
• Placement of the Stent: The doctor locates the blockage using X-ray guidance, and then a stent is threaded through the tube and positioned at the site of the blockage. The stent is then expanded to open up the blocked duct.

Biliary Stenting Recovery Plan

Recovery from biliary stenting may involve:

• Monitoring: After the procedure, the patient is typically monitored for a few hours to ensure no immediate complications.
• Eating and Drinking: Once fully awake, the patient can start drinking fluids and then eat.
• Pain Management: Some discomfort or pain is normal after the procedure. The healthcare provider may prescribe pain relievers as needed.
• Follow-Up Appointments: The patient must attend follow-up appointments to monitor their progress. If a temporary stent was placed, a plan for when and how it will be removed will be made.
• Managing Symptoms: If the patient experiences fever, severe abdominal pain, jaundice, or other concerning symptoms after the procedure, they should contact their healthcare provider immediately, as these could be signs of complications.

Biliary Stenting Prognosis

The prognosis after biliary stenting greatly depends on the underlying cause of the bile duct blockage.

Biliary stenting can temporarily alleviate symptoms before definitive treatment, like surgery for benign conditions like gallstones or inflammation. The prognosis is usually good in these cases, with significantly reduced symptoms.

In cases of malignant obstruction, biliary stenting is often performed as palliative care to relieve symptoms and improve the patient's quality of life. The stage and type of cancer generally determine the prognosis in these situations, and while stenting can provide significant symptom relief, it does not cure the cancer itself.

Biliary Stenting Risks

Like any medical procedure, biliary stenting carries some risks, including:

• Infection: There's a risk of infection in the bile ducts after the procedure.
• Bleeding: Although rare, there can be a risk of bleeding during or after the procedure.
• Perforation: There's a small risk that the procedure could create a hole in the bile duct, gallbladder, or intestine.
• Stent Migration: The stent can move from its original position, requiring another procedure to reposition or replace it.
• Stent Blockage: Over time, the stent can become blocked, which may require replacing it.
• Post-ERCP Pancreatitis is an inflammation of the pancreas that can occur after the ERCP procedure used to place the stent.

What if Biliary Stenting is Delayed?

Delaying biliary stenting can lead to a worsening of symptoms and potential complications. These could include:

• Increased Jaundice: The buildup of bilirubin due to blocked bile ducts can lead to increased jaundice, characterised by yellowing of the skin and eyes.
• Infection (Cholangitis): Without treatment, bacteria can increase in the stagnant bile, leading to an infection of the bile ducts.
• Liver Damage: Over time, blockage of the bile ducts can cause liver damage, potentially leading to cirrhosis or liver failure.
• Sepsis: If an infection in the bile ducts spreads to the bloodstream, it can lead to life-threatening sepsis.