Biliary Stenting in Lucknow

A blocked bile duct stops bile from reaching the bowel, and bilirubin, the yellow pigment in bile, builds up in the blood. Bile is a digestive fluid made in the liver. It travels down the bile ducts and helps the body digest fat.

The raised bilirubin causes jaundice, a yellow colour of the eyes and skin, together with dark urine, pale stools, itching and often upper abdominal pain. Loss of appetite and weight loss can occur. Anyone with jaundice should see a doctor soon. Fever with chills can mean that the blocked bile has become infected, which is an emergency.

Common causes are stones in the duct, a narrowing called a stricture after surgery or inflammation, and tumours of the bile duct, gallbladder, pancreas or liver. Enlarged lymph nodes pressing from outside can also block a duct.

A stent is a thin tube, made of plastic or expandable metal mesh, that is placed across the blockage to keep the duct open. Bile then flows past the narrowing.

It can be placed in two main ways. In the endoscopic route, called ERCP, a flexible camera passes through the mouth to the duct opening in the bowel, and the stent is passed up the duct from there. In the percutaneous route, a fine needle is passed through the skin and liver into a bile duct, guided by ultrasound and live imaging. A wire is passed across the blockage and the stent is placed over it.

Sometimes a drain is placed first to clear infection and relieve the pressure, and the stent follows later. That drain is called PTBD, and it is a separate procedure.

A stent is used when a blocked duct needs to be opened and the blockage cannot be removed, or is waiting for other treatment. This often applies to a blockage from a tumour of the pancreas, bile duct or gallbladder, or to a stricture that cannot be treated another way. Stones are usually removed rather than bypassed.

A stent relieves the blockage. It does not treat the cause. Stents can block over time, especially plastic ones, or move out of place. Another procedure to clear or change a stent may be needed.

The risks include the following:

• Infection of the bile ducts (cholangitis), which causes fever and can be serious.
• Bleeding from the liver or the puncture track, which can sometimes need further treatment.
• Bile leak into the abdomen, causing pain.
• Pancreatitis, which is inflammation of the pancreas, after an endoscopic stent.
• Stent problems: blockage, movement, or the stent not fully relieving the jaundice.
• Anaesthesia and dye reactions, which the team explains.

The first tests are a blood test of bilirubin and liver enzymes, such as a liver function panel, and an ultrasound of the abdomen. Ultrasound often shows widened bile ducts above a blockage and may show stones, but it can miss the exact level or the cause.

A detailed scan, usually a CT or an MRI with views of the ducts called MRCP, shows where the blockage is and what is causing it. We do not perform CT or MRI scans. Ask your doctor where to have them done, and our team can review the images and reports.

If the cause is not clear, a biopsy may be needed. A specialist team, which may include a liver and bile duct surgeon, a gastroenterologist, an oncologist and an interventional radiologist, decides the route.

Our team reviews your referral, images and reports first. It then confirms whether the stent is placed at the centre or elsewhere, and by whom.

The route depends on where the blockage is, what causes it and your general health. Your specialist chooses.