- Cholangiogram through existing catheter
- Biliary covered metallic stent placement
- Biliary catheter replacement
Indication: Pancreatic cancer and biliary obstruction
Medications: mg IV Versed, mcg IV fentanyl and 3.375 gm IV Zosyn
Contrast: mL non-ionic
Fluoro time: minutes
Catheter: F Amplatz anchor external biliary drain
Device: 0 mm x cm Gore VIABIL covered biliary stent
Complications: None immediate
The risks, benefits, and alternatives to the procedure and sedation were explained to the patient. The specific risks of stent mal deployment or migration and sepsis were detailed and accepted. Written informed consent was obtained. A time out/call to order was performed prior to procedure initiation.
The existing catheter and surrounding soft tissues were prepped and draped in sterile fashion. Local anesthetic was injected at the catheter entry site.
Contrast was injected through the existing biliary drainage catheter and cholangiographic images obtained.
A wire was negotiated through the catheter and into small bowel. The catheter was removed over the wire, and a short 10 French sheath placed. A 5 French marker pigtail catheter was placed over the wire into small bowel. A cholangiogram was performed through the sheath and pigtail, demarcating the location of the ampulla and biliary confluence.
Lesion length was measured and the Viabil stent advanced over the wire and positioned using fluoroscopy. The stent was deployed, and the sheath re-injected. The lesion and stent were dilated with a mm balloon. A final cholangiogram was performed through the sheath.
A new, F Amplatz anchor was placed over the wire The catheter was positioned . The catheter was secured to the flank in the usual manner. The tube was capped or attached to gravity drainage.
The procedure was well tolerated, and the patient discharged in satisfactory condition.
Findings: Comparison is made with .
- A stricture extends from the , consistent with cancer.
- The covered stent is appropriately positioned, extending from .
- There is prompt antegrade flow through stent on the completion cholangiogram.
- additional findings.
- Malignant stricture of the secondary to cancer.
- A covered stent was successfully deployed.
- The intrahepatic bile ducts are dilated.
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