What is a Biliary Stent?

A biliary stent is a tube that is inserted into the common bile duct of the liver in cases when the duct has become blocked. The stent is inserted after surgery to unblock the duct and ensure that it remains inflated and operative. The biliary stent is made of inert substances such as plastic or metal, which are unlikely to provoke an immune response.

The liver plays an important role in digestion by producing bile, which is necessary for breaking down fats. Bile drains from the liver to the common bile duct, and this duct empties into the portion of bowel that receives partially digested food from the stomach. Blockage of the common bile duct prevents normal liver function and affects digestion.

The most common cause of non-malignant bile duct blockage is injury to the duct during gallbladder removal surgery. Common bile duct blockage also can be caused by traumatic injury to the abdomen, gallstones or inflammation of the pancreas, which is located beneath the liver. Bile ducts themselves also can become inflamed, in a condition called primary sclerosing cholangitis. All of these conditions might require treatment with a biliary stent to correct the duct blockage problem.

In a biliary stenting surgical procedure, a catheter is first inserted into the blocked bile duct to allow the duct to drain. Next, a biliary stent is inserted. There are two different methods by which the stent can be placed: endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC).

ERCP involves the use of a lighted, hollow tube called an endoscope. The tube is fed into the patient’s mouth, through the esophagus and stomach to the point at which the common bile duct empties into the small intestine. Once the endoscope is in place, a second tube called a cannula is inserted. The cannula is used to inject colored dye into the bile duct.

Next, X-rays of the abdomen are taken. The dye improves the contrast of the X-rays, so that bile duct blockages can be located easily. If a biliary stent is needed, it is inserted through the catheter and placed at the site of blockage as pinpointed on the high-contrast X-rays.

In some cases, ERCP is unable to locate the sites of bile duct blockage. When this occurs, PTC might be used to try to locate a blocked bile duct. In this procedure, contrast dye is injected through the skin, and X-rays are taken. If a stent is needed, a hollow needle is inserted into the skin, and the stent is inserted into the blocked duct through the needle.

Most cases of non-malignant bile duct blockage can be treated successfully with one of these biliary stenting procedures. Following the procedure, patients might remain in the hospital for only a few hours or overnight. The length of the stay depends on the patient's overall physical health and the presence of any risk factors for complications such as infection or jaundice. Possible complications include gallbladder inflammation, bile duct inflammation and infection.