How is a biliary stent inserted?

A biliary stent is inserted using a minimally invasive procedure, typically via endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD) if ERCP is not feasible.

1. Endoscopic Retrograde Cholangiopancreatography (ERCP) (Most Common Method)

Preparation:

• The patient fasts for several hours before the procedure.

• Sedation or general anesthesia is administered.

Procedure Steps:

1. Endoscope Insertion: A flexible tube (endoscope) is passed through the mouth, esophagus, and stomach into the duodenum (first part of the small intestine).

2. Bile Duct Identification: A contrast dye is injected through a small catheter to visualize the bile ducts under X-ray (fluoroscopy).

3. Blockage Location: The doctor locates the obstruction in the bile duct.

4. Stent Placement: A guidewire is advanced into the bile duct, and the stent is positioned at the blockage site.

5. Stent Expansion: If a self-expanding metal stent (SEMS) is used, it expands on its own; plastic stents require manual positioning.

6. Final Check: The physician confirms proper placement using imaging before removing the endoscope.

Recovery:

• Patients are monitored for a few hours and usually discharged the same day.

• Some may experience mild discomfort, bloating, or nausea.

2. Percutaneous Transhepatic Biliary Drainage (PTBD) (Alternative Method)

When Used?

• If ERCP is not possible, such as in cases of surgically altered anatomy or complete bile duct obstruction.

Procedure Steps:

1. Local Anesthesia & Imaging: The skin is numbed, and ultrasound or fluoroscopy guides the procedure.

2. Needle Insertion: A needle is inserted through the skin into the liver to access the bile ducts.

3. Guidewire & Catheter Placement: A guidewire and catheter are inserted, allowing bile to drain externally or internally.

4. Stent Insertion: A stent is passed over the guidewire to keep the duct open, allowing bile to flow normally.

Recovery:

• Hospitalization may be required for a day or more.

• There may be mild pain at the insertion site.

Both methods effectively restore bile flow and relieve symptoms. Stents may be temporary or permanent, depending on the condition being treated.