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.

During the test, you will lie on your left side or on your stomach. The doctor puts the scope in your mouth and then gently moves it toward the back of your throat. The doctor will tell you when to swallow. This helps the scope move down your throat. You will be able to breathe normally.

Then the doctor moves the scope through the tube (esophagus) that leads to your stomach, through your stomach, and into the first part of your small intestine. When the scope reaches the place where the bile ducts and the pancreas meet the small intestine, you may be asked to turn and lie on your stomach. The doctor then guides the stent into place.

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.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

What happens before the procedure?

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

• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, and natural health products you take. Some of these can increase the risk of bleeding or interact with anesthesia.
• If you take aspirin or some other blood thinner, be sure to talk to your doctor. He or she will tell you if you should stop taking it before your procedure. Make sure that you understand exactly what your doctor wants you to do.
• Your doctor will tell you which medicines to take or stop before your procedure. You may need to stop taking certain medicines a week or more before the procedure. So talk to your doctor as soon as you can.
• If you have an advance directive, let your doctor know. It may include a living will and a durable power of attorney for health care. Bring a copy to the hospital. If you don't have one, you may want to prepare one. It lets your doctor and loved ones know your health care wishes. Doctors advise that everyone prepare these papers before any type of surgery or procedure.

What happens on the day of the procedure?

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be cancelled. 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 jewellery and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery centre

• 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.

Going home

• Be sure you have someone to drive you home. Anesthesia and pain medicine make it unsafe for you to drive.
• You will be given more specific 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.

When should you call your doctor?

• You have questions or concerns.
• You don't understand how to prepare for your procedure.
• You become ill before the procedure (such as fever, flu, or a cold).
• You need to reschedule or have changed your mind about having the procedure.