Procedures:
- Cholangiogram through existing catheter
- Biliary covered metallic stent placement
- Biliary catheter replacement
Indication: Pancreatic cancer and biliary obstruction
Date:
Operators:
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
Technique:
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.
Impression:
- Malignant stricture of the secondary to cancer.
- A covered stent was successfully deployed.
- The intrahepatic bile ducts are dilated.
Plan:
when will pt return?
Frequently Asked Questions
What is a biliary stent and why is it used?
A biliary stent is a small tube inserted into the bile duct to keep it open, allowing bile to drain from the liver to the small intestine. It is often used when there is a blockage due to conditions like pancreatic cancer or biliary obstruction. Stents can help relieve symptoms such as jaundice and improve liver function.
The procedure involves inserting a wire through an existing catheter into the small bowel. A sheath is then placed, and a cholangiogram is performed to guide the stent's positioning. The stent is advanced over the wire and deployed using fluoroscopy. The area is then dilated with a balloon to ensure the stent is properly positioned, and a new catheter is placed if necessary.
What are the risks associated with biliary stent placement?
The risks include stent maldeployment, migration, and potential infection or sepsis. However, these risks are generally low, and the procedure is often well tolerated. Patients are informed of these risks, and consent is obtained before proceeding.
What happens after a biliary stent is placed?
After placement, a final cholangiogram is performed to ensure proper positioning and function of the stent. The catheter may be capped or attached to gravity drainage. Most patients tolerate the procedure well and can be discharged once stable, with follow-up appointments scheduled to monitor the stent's function.
A cholangiogram involves injecting contrast material into the bile ducts and taking X-ray images to visualize the biliary system. It helps in identifying the exact location and severity of any blockages, guiding the placement of stents or catheters and ensuring that the procedure is performed accurately.
A covered metallic stent is a type of stent with a special coating that helps prevent tissue ingrowth and reduces the risk of blockage. These stents are beneficial in managing malignant strictures, such as those caused by pancreatic cancer, by maintaining bile flow and reducing complications.
How long does it take to recover from a biliary stent placement?
Recovery from a biliary stent placement is usually quick, as it is minimally invasive. Patients often go home the same day if there are no complications. Some soreness at the insertion site is normal, and patients should follow post-procedure instructions and attend follow-up visits for optimal recovery.