Endoscopic Biliary Stenting

WHAT YOU SHOULD KNOW:

• Endoscopic biliary stenting is a procedure done to open your blocked bile duct (tube). During the procedure, a stent is placed into your blocked bile duct. A stent is a small plastic or metal tube that is used to keep your bile duct open. Bile (fluid from your liver) helps you digest fat and other foods that you eat. Bile is stored in your gallbladder, which is located under your liver. Bile passes through your bile duct and is released into your intestines (bowels) when you eat.
  
  
• The flow of bile may be blocked by tumors (cancers), gallstones, or strictures (narrowings) of your bile duct. Gallstones are hard objects that form in your gallbladder. Stents help widen the narrowed area of your bile duct and allow the bile to flow through. Your caregiver will use an endoscope to put the stent inside your blocked bile duct. An endoscope is a long bendable tube with a light and camera at the end. Biliary stent placement may decrease your symptoms such as jaundice (yellowing of skin and the whites of eyes). Endoscopic biliary stenting may also resolve itching, abdominal (stomach) and back pain, and improve your liver function.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• You may have an allergic response to the medicines used for your procedure. You may get a sore throat and hoarse (rough) voice from having the endoscope in your throat. The endoscope or wire used may tear an area of your stomach or bowel wall and cause bleeding. The stent may become clogged or blocked by a growing tumor, thickened bile, or gallstones. The stent may also loosen and move out of place causing a blockage. Stents may also cause swelling of other body organs, such as your pancreas and gallbladder. If your bile duct is damaged, it may leak bile fluid into your abdomen. If bile leakage occurs, you may get an infection and you may die.
  
  
• Even with stent placement, you may have further narrowing of your bile duct. Without biliary stenting, your condition may get worse. Your symptoms, such as jaundice and itchy skin may become severe (very bad). Your liver may become damaged from the blockage and not function correctly. Your gallbladder may also break open if you have gallstones or pressure from too much bile. If your gallbladder breaks open, you are a risk for a serious infection and you may die. Talk to your caregiver if you have questions or concerns about your condition, procedure, or care.

WHILE YOU ARE HERE:

Before your procedure:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pre-op care: You may be given medicine in your IV right before your procedure. This medicine may help you relax or make you sleepy. Antibiotic medicine may also be given to prevent infection after your procedure. You may be taken on a stretcher to the room where your procedure will be done. You will then be moved to a table or bed.
  
  
• Local anesthesia: This is medicine used to numb your throat. You may still feel pressure or pushing in your throat during the procedure, but you should not feel pain. Local anesthesia may also help prevent you from coughing and gagging when the endoscope is placed in your throat.
  
  
• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

During your procedure:

• An endoscope will slowly be put into your mouth and down your throat. The scope will be moved down into your stomach and small intestine (bowel) until it reaches your bile duct. A camera at the end of the endoscope will show the inside of your stomach and intestines (bowels). The pictures will show up on a TV-like screen. Fluoroscopy (special x-ray) may be used during your procedure to guide the stent placement. During fluoroscopy a dye is injected into your bile duct opening. The dye will allow your bile duct to be seen clearly on an x-ray. This procedure will also help your caregiver see if you have gallstones, tumors, or narrowing of your bile duct.
  
  
• A thin guide wire is slowly put through the endoscope with the help of fluoroscopy. The wire is inserted past the narrowed area of your bile duct. The stent will be slid over the wire to the area of your blockage. Once the stent is in place, the wire will be removed. A sample of your bile duct tissue may be removed and sent to a lab for testing. A portion of your bile duct may also be removed if it is causing part of your blockage. When your procedure is finished, the endoscope will be removed. An x-ray of your abdomen may be done to check the position of the stent.

After your procedure:

You will be taken to a room where you will rest until you are fully awake. Do not get out of bed until your caregiver says it is OK. When your caregiver sees that you are OK, you may be able to go home. If you are staying in the hospital, you will be taken back to your hospital room.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.