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.

Getting Ready

Before your procedure:

• Ask someone to drive you home when you are ready to leave the hospital. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• You may need to see a dietician (nutrition caregiver) if you are losing weight without trying. A dietician will teach you about the best foods for you to eat or avoid with your condition. The dietician may also put you on a special diet before your procedure.
  
  
• You may need to see your caregiver for a physical exam before your procedure. You may need to have a computerized tomography (CT) scan, magnetic resonance imaging (MRI), or an ultrasound. You may also need blood tests to check your liver and other body functions. Ask your caregiver for more information about these and other tests you may need. Write down the date, time, and location of each test.

The day of your procedure:

• Write down the correct date, time, and location of your procedure.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• Antibiotics: Antibiotics may be given to help prevent an infection caused by germs called bacteria.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

Treatment

What will happen:

• During your procedure you may get conscious sedation (short-acting, light sedation). You may be given medicine in your IV to help you relax or make you drowsy. Your throat may also be numbed with anesthesia medicine. You may still feel pressure or pushing during the procedure, but you should not feel pain. During your procedure, you will be placed in a side lying position. 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.
  
  
• Dye may also be inserted through the scope and into the opening of your bile duct. The dye will allow your bile duct to be seen more clearly with fluoroscopy (special x-ray). The dye will also help your caregiver see if you have gallstones, tumors, or narrowing of your bile duct. The fluoroscopy will also guide your caregiver when putting in your stent. A thin wire will be put through the scope and deep in 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 and endoscope will be removed. An x-ray of your abdomen may be needed 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 room.

Contact a caregiver if

• You cannot make it to your procedure.
  
  
• You have an upset stomach or you start to vomit (throw up).
  
  
• You have very light colored bowel movements (BMs).
  
  
• You have back pain.
  
  
• You have yellow, itchy skin.
  
  
• You have yellowing of the whites of your eyes.

Seek Care Immediately if

• You are losing weight without trying.
  
  
• You have a fever (high body temperature), or chills.
  
  
• You have bad pain in the right upper area of your abdomen.
  
  
• Your abdomen is hard and swollen.

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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.