Views: 8 Author: Site Editor Publish Time: 2024-12-31 Origin: Site
A self-expanding biliary stent (SEBS) can sometimes experience complications or malfunctions after being placed. Recognizing the signs of a malfunction is crucial for timely intervention to prevent further issues. Here are the common signs and complications associated with a malfunctioning or problematic self-expanding biliary stent:
Cause: Jaundice occurs when the biliary system is obstructed and bile flow is impaired, either due to stent blockage or migration. This is often one of the first signs that the stent is no longer functioning properly.
When to worry: If jaundice develops after the stent has been placed and the patient had previously been improving, it may indicate stent occlusion (blockage), stent migration, or tumor ingrowth.
Cause: Abdominal pain, especially in the upper right quadrant (where the liver and biliary system are located), can signal that the stent is causing inflammation, infection, or obstruction.
When to worry: Pain may also be associated with complications like pancreatitis (inflammation of the pancreas), cholangitis (infection of the bile duct), or biliary colic (pain caused by gallstones or bile duct problems).
Cause: Fever or chills may indicate an infection in the bile ducts, often referred to as cholangitis. This can occur if the stent becomes obstructed or infected.
When to worry: A fever, especially if accompanied by pain, nausea, or vomiting, requires immediate medical attention as it can be a sign of a serious infection that needs urgent treatment.
Cause: If the stent is displaced or damaged, there may be a leak of bile into the abdominal cavity or other organs, causing symptoms like ascites (fluid buildup in the abdomen).
When to worry: A bile leak can be life-threatening and requires prompt medical evaluation and intervention. This may be signaled by swelling, distension, or pain in the abdomen.
Cause: Although self-expanding biliary stents are designed to anchor securely in the bile duct, they can sometimes migrate (move out of place) if they were not positioned correctly or if the bile duct is too loose or has changed shape.
When to worry: If the stent moves out of the bile duct, it can cause a bile duct obstruction, infection, or pancreatitis. Symptoms of migration include worsening jaundice, abdominal pain, and fever.
Cause: Over time, self-expanding biliary stents can become blocked by debris, tumor ingrowth, bile sludge, or strictures. This can prevent bile from draining properly.
When to worry: Blockage leads to symptoms of recurrent jaundice, abdominal pain, nausea, vomiting, and sometimes fever. Imaging studies (like an ERCP or ultrasound) are needed to confirm blockage and evaluate its severity.
Cause: In patients with malignant biliary obstructions, tumor cells can grow through the stent (especially in covered stents) or around it, leading to stent obstruction.
When to worry: Signs of tumor ingrowth include worsening jaundice, pain, and lack of improvement or recurrence of symptoms after stent placement. Tumor ingrowth can lead to the stent becoming ineffective at draining bile.
Cause: Infection in the bile ducts can occur due to bile stasis (blocked or slow bile flow) or contamination during the stent insertion procedure. Stent-related cholangitis is more likely if the stent becomes blocked or if there’s an issue with the bile duct, such as stricture.
When to worry: Symptoms of cholangitis include fever, pain, jaundice, and elevated liver function tests. This is a serious complication and often requires immediate medical intervention with antibiotics and possible stent adjustment or replacement.
Cause: In rare cases, the stent can fracture due to mechanical stress, movement, or improper placement. This can occur with metal stents (e.g., nitinol) if the patient has abnormal biliary anatomy or if the stent is subjected to external forces.
When to worry: Symptoms may include acute pain, blockage, or infection due to debris or bile leakage. A fractured stent may require endoscopic removal or replacement.
Cause: If the stent is not draining bile effectively due to any of the complications mentioned above, liver function tests (LFTs) can show elevated bilirubin, alkaline phosphatase (ALP), and transaminases (AST/ALT). This indicates that the liver is under stress due to biliary obstruction.
When to worry: Elevated liver enzymes along with worsening clinical signs (e.g., jaundice, pain) may suggest that the stent is malfunctioning or causing a blockage.
Cause: These symptoms can occur due to a biliary obstruction or infection resulting from stent malfunction. If the stent causes a partial or full blockage, the bile cannot drain properly, leading to bile reflux and gastrointestinal symptoms.
When to worry: If nausea and vomiting persist or worsen over time, it could be due to gastrointestinal complications related to the stent.
Persistent or worsening jaundice despite stent placement
Abdominal pain that is increasing in intensity or does not improve
Fever or chills suggesting infection (cholangitis)
New onset of nausea and vomiting
Changes in liver function tests that suggest ongoing obstruction
If any of these symptoms arise, it’s important to contact a healthcare provider immediately. The provider will often perform diagnostic tests, such as imaging studies (ultrasound, CT, MRCP), endoscopic retrograde cholangiopancreatography (ERCP), or blood tests, to assess the stent’s position, patency, and overall function.
In some cases, further intervention may be needed, such as:
Stent removal or replacement
Balloon dilation of the bile duct
Antibiotic therapy for infections like cholangitis
Surgical intervention if the stent cannot be corrected endoscopically
Prompt recognition of complications and appropriate management are key to preventing serious outcomes and improving patient prognosis.
