Stent biliary

Contrast medium is injected into the bile ducts via an endoscopic tube. X-rays are then used to visualise the pancreas and biliary tree. Gallstones can be removed during ERCP and stents can be inserted to widen narrowed bile ducts, which may be the cause of jaundice. 

Edelman, K. Multiple pyogenic hver abscesses communicating with the biliary tree treatment by endoscopic stenting and stone removal. Amer. J. Gastroenterol. 1994 89 2070-2072... 

Rossi, R, Saivatori, F.M., Bezzi, M., Maccioni, R, Rorcaro, M.L., Ricci, R Percutaneous management of benign biliary strictures with balloon dilatation and selfexpanding metallic stents. Cardiovasc. Intervent. Radiol. 1990 13 231-239... 

Ursodeoxycholic acid 250 mg tds plus ofloxacin 200 mg bd has been compared with ursodeoxycholic acid alone in the prevention of occlusion of biliary stents in a randomized trial in 52 patients with inoperable obstructive jaundice (6). Combination treatment was not superior to ursodeoxycholic acid alone. There was no significant difference in the frequency of adverse events between the two groups. 

Halm U, Schiefke, Fleig WE, Mossner J, Keim V. Ofloxacin and ursodeoxycholic acid versus ursodeoxycholic acid alone to prevent occlusion of biliary stents a prospective, randomized trial. Endoscopy 2001 33(6) 491-4. 

Lee BH, Choe DH, Lee JH, Kim KH and Chin SY (1997) Metallic stents in malignant biliary obstruction prospective long-term clinical results. Am J Roentgenol 168 741-745. 

Rai R, Rose J, Manas D (2003) Potentially fatal haemobilia due to inappropriate use of an expanding biliary stent. World J Gastroenterol 9 2377-2378... 

The Gianturco stent is seldom used in the treatment of mahgnant biliary strictures because of the high rates of tumor ingrowth through the wide mesh. 

Table 1.1. Retrospective outcome analyses of plastic stents in malignant biliary obstruction...

Fig. 1.6a-d. Rendezvous procedure for a distal CBD stricture with failed endoscopic retrograde cholangiography, a CT shows a distal biliary obstruction along with multiple liver metastasis (arrow), b The stricture of the distal common bile duct was negotiated and an 8-F multi-sidehole catheter was inserted (arrow). This facilitated endoscopic bile duct cannulation (c) and subsequent stent placement (d)... 

Despite intensive efforts to improve plastic endoscopic stents, few modifications have proved advantageous. Plastic stents are simple single lumen devices designed to function as an aqueduct for bile. Conventional plastic Cotton-Leung biliary stents, composed of polyethylene, have single flaps at both ends of the stent The stents are available in varied lengths from 3 to 20 cm ranging in diameters from 7 to 11 F. (Fig. 1.8)... 

Fig. 1.8. Conventional plastic biliary stent with one flap at each end...

Endoscopic placement of a biliary stent is successful in more than 90% of patients. Overall success is... 

The cholangiographic findings during ERCP should be used to aid stent selection. The length of the chosen stent should be based on measurements obtained with a ruled catheter or wire that can be pulled through the stricture (Seibert 1997). Ideally, plastic stents should completely span the stricture and protrude 1-2 cm from the ampulla. Performance of a biliary sphincterotomy prior to stent placement may reduce the incidence of acute pancreatitis in patients who have a proximal stricture of the bile duct (Tamsky et al. 1997). Other reports suggest that the routine use of biliary sphincterotomy increases the duration of the procedure as well as the complication rate (Margulies et al. 1999). 

Burcharth F (1978) A new endoprosthesis for nonoperative intubation of the biliary tract in malignant obstructive jaundice. Surg Gynecol Obstet 146 76 Catalano MF, Geenen JE, Lehman GA et al (2002) Tannen-baum Teflon stents versus traditional polyethylene stents for treatment of malignant biliary stricture. Gastrointest Endosc 55 354-358... 

Cremer M, Deviere J, Sugai B et al (1990) Expandable biliary metal stents for malignancies endoscopic insertion and diathermic cleaning for tumor ingrowth. Gastrointest Endosc 36 451-457... 

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