Stent insertion

One of the frequent symptoms of cholangiocarcinoma is jaundice.  This happens because the bile duct or ducts become blocked, preventing the normal flow of bile from the liver to the intestines.   To allow the bile to flow again, a stent (usually a metal stent) will be inserted into the bile duct to hold it open.  This will relieve the symptoms of jaundice, the patient’s general health will then improve and they are able to digest food again normally.   (If chemotherapy has been recommended, it is essential this happens before it can begin.)

A stent usually needs to be replaced every 3-4 months as they can become blocked, and cause a biliary tract infection (cholangitis), which can rapidly become serious.  Symptoms of a blocked stent/infection include:

  • high temperature/fever
  • jaundice
  • chills, shivering

If these symptoms develop, it is important to contact the doctor or CNS (Clinical Nurse Specialist) for advice, as antibiotic treatment may be needed and the stent may need to be replaced.

A stent is a tube put into the bile duct to hold it open and allow bile to drain away. The tube is about as thick as a ball-point pen refill and 5-10cm long (2-4 inches).  A stent may be put in using an ERCP or occasionally a PTC procedure:

The ERCP method (ERCP = endoscopic retrograde cholangiopancreatography)

The preparation and procedure is the same as for ERCP used diagnostically. By looking at the x-ray image the narrowing in the bile duct can be seen. The narrowing is stretched using dilators (small inflatable balloons), and the stent is inserted through the endoscope so that the bile can drain.

The PTC method (percutaneous transhepatic cholangiography)
The procedure and preparation is as for PTC used diagnostically. A temporary wire is passed to the area of blockage and the stent is guided along the wire. Sometimes a drainage tube (catheter) is left in the bile duct. One end of the catheter is in the bile duct and the other stays outside the body connected to a bag, which collects the bile. This is to help with the insertion of the stent or, sometimes, to enable x-rays to be taken to check the position of the stent after it has been put in place. It is usually left in for a few days. Once the catheter is removed the hole will heal over, usually within two days.

Sometimes a combination of ERCP and PTC may be used.

Antibiotics are given before and after the procedure to help prevent infection, and it is likely that a few days in hospital will be required.

A stent usually needs to be replaced every 3-4 months to prevent it becoming blocked – high temperatures and/or jaundice are symptoms of this. If these symptoms develop, antibiotic treatment may be needed and the stent may be replaced.

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