Biliary Stent Placement in Obstructive Jaundice

Bile is produced in the liver and is essential for the digestion of foods. However, bile flow can sometimes become obstructed. This condition leads to a health issue known as obstructive jaundice. Although the disease is not contagious, it can cause serious complications. To overcome this obstruction, placement of biliary stents is a frequently used method. This procedure helps restore bile flow to normal, providing relief to the patient. It is particularly effective in clearing blockages in the gallbladder and bile ducts.

Catheter Placement in Non–Cancer-Related Obstructive Jaundice

Since externally placed metallic stents cannot be removed, in benign obstructions a catheter is placed via the percutaneous transhepatic cholangiography (PTC) method and removed once the issue is resolved. Alternatively, plastic stents that can be removed later via endoscopic techniques may be tried.

What Are the Causes of Obstructive Jaundice?

Obstructive jaundice can develop due to various factors. In this condition, bile flow is blocked, leading to serious health problems. The most common causes of bile duct obstructions include:

• Bile stones: Solid formations in the gallbladder and ducts.
• Tumors: Can develop in the bile ducts, gallbladder, and pancreas, including:
  • Cholangiocarcinoma
  • Gallbladder cancer
  • Pancreatic cancer
  • Metastatic cancers
• Scar tissue: Particularly after previous bile duct surgeries.

These causes lead to blockage of the bile ducts and cessation of bile flow. In such cases, toxic substances accumulate in the body, causing serious health issues.

What Are the Symptoms of Obstructive Jaundice?

Obstructive jaundice presents with distinct symptoms due to blocked bile flow. Patients often notice yellowing of the skin and the whites of their eyes. This results from bile pigments entering the bloodstream. Additionally, urine darkens while stool lightens, indicating bile duct obstruction. Skin itching occurs due to bile salts accumulating under the skin. As the condition progresses and bile ducts become inflamed, patients may develop:

• Fever
• Chills
• Shivering
• Abdominal pain

These symptoms indicate complications arising from bile duct obstruction.

How Is Obstructive Jaundice Diagnosed and Treated?

In treating obstructive jaundice, biliary stent placement is a key option. This therapy aims to relieve obstructions blocking bile flow from the liver through the gallbladder into the duodenum. Obstructions in the bile ducts are usually caused by stones, tumors, or inflammations. Stent placement mechanically opens these blockages, restoring normal bile flow.

The stent placement process is performed using interventional radiology techniques. While the patient is under anesthesia, several steps are followed. First, imaging is performed to assess the bile ducts. This method is called Percutaneous Transhepatic Cholangiography (PTC). PTC is used to visualize the bile ducts in detail and determine the location and cause of the obstruction. During this procedure, a fine needle is inserted through the skin into the liver, and contrast medium is injected into the bile ducts to obtain radiologic images. These images clearly reveal the anatomy of the bile ducts and the details of the obstruction, allowing planning of the appropriate treatment. This step is critical for identifying the location and cause of the obstruction. After imaging, a thin tube and guidewire are advanced to the obstruction site. The tube is advanced to the blockage, and the stent is deployed in this region. Once the stent expands, the obstruction is relieved and bile can flow normally again.

In benign obstructions, stents are not preferred; instead, catheters that can be removed later are placed. The catheter is removed once the problem is resolved.

Stent placement usually requires the patient to be observed in the hospital for a few hours. Most patients can go home the same day. The home recovery period varies depending on the patient’s overall health and any complications encountered during the procedure.

There are some risks associated with stent placement:

• Infection: As with any surgical intervention, there is a risk of infection.
• Bleeding: There may be minor bleeding during stent placement.
• Stent migration or occlusion: Over time, the stent may move or become blocked.

Stent placement can be applied in the following conditions:

• Bile duct stones: Large stones obstructing the bile ducts.
• Bile duct tumors: Tumors that block bile flow.
• Inflammatory strictures: Narrowing of the bile ducts due to inflammation.

What to Do After Biliary Stent Placement?

After biliary stent placement, the patient’s recovery process is carefully managed. The stent restores normal bile flow, reducing jaundice, and significant improvement is usually observed within 15–20 days. During this period, the patient’s condition is closely monitored:

• If necessary, medical therapy may be initiated. This treatment is usually chemotherapy, adjusted according to the patient’s overall health.
• Regular blood tests are performed to assess treatment effectiveness and monitor potential side effects. These tests are critical for evaluating therapy and detecting complications.

Additionally, computed tomography scans are performed at intervals to check stent patency and detect any complications.

Prof. Dr. Özgür KILIÇKESMEZ

Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.