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 _____tricture 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 biliary stent placement?
Biliary stent placement is a procedure used to open a blocked bile duct, often due to conditions like pancreatic cancer. A stent, which is a small tube, is inserted into the bile duct to allow bile to flow freely into the small intestine. This can relieve symptoms like jaundice and prevent further complications.
Why might someone need a biliary stent?
A biliary stent is typically needed when there is a blockage in the bile ducts, often due to tumors, strictures, or stones. In the context of pancreatic cancer, the tumor may press on the bile duct, causing an obstruction that leads to jaundice, pain, or liver dysfunction.
How is a biliary stent placed through an existing catheter?
In this technique, a wire is guided through an existing catheter into the bile duct and small bowel. The catheter is then removed, and a sheath is placed to facilitate the insertion of the stent. The stent is positioned with the help of imaging techniques like fluoroscopy and then deployed to open the duct.
What are the risks associated with biliary stent placement?
Risks include stent maldeployment or migration, sepsis, bleeding, and infection. However, these risks are generally low when the procedure is performed by experienced professionals. It’s important to discuss these risks with your healthcare provider before the procedure.
What should patients expect after a biliary stent placement procedure?
Patients can usually expect a quick recovery, often being discharged the same day if there are no complications. They may experience mild discomfort at the catheter site, which can be managed with pain relief medication. It's crucial to follow up with the healthcare provider to monitor the stent’s function.
How does a cholangiogram help in biliary stent placement?
A cholangiogram is an imaging test that uses contrast dye to highlight the bile ducts. During the procedure, it helps the doctor see the location and extent of a stricture or blockage. This information is crucial for accurately positioning the stent to ensure it effectively relieves the obstruction.
What is the role of fluoroscopy in this procedure?
Fluoroscopy is an imaging technique that provides real-time X-ray images, allowing the physician to see the bile ducts and the placement of instruments during the procedure. It ensures that the stent is accurately positioned and deployed, reducing the risk of complications.
Covered metallic stents are beneficial because they help prevent tissue ingrowth, which can occur with uncovered stents, potentially leading to re-obstruction. They are particularly useful in malignant obstructions, as they offer a longer-lasting solution compared to plastic stents.