Biliary stenting

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Biliary stenting is an interventional procedure in which a stent (plastic or metallic) is placed within the bile duct to relieve biliary obstruction. It can be performed via endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic route (PTBD) if ERCP fails or anatomy is altered.

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Indications

Type	Indication
Malignant obstruction
(most common)	• Cholangiocarcinoma
• Pancreatic carcinoma
• Gallbladder carcinoma
• Metastatic porta hepatis nodes
Benign strictures	• Postoperative (post-cholecystectomy, post-liver transplant)
• Chronic pancreatitis
• Post-radiation or inflammatory strictures
Bile leaks & fistulae	Post-cholecystectomy, post-transplant
As an adjunct	• Before surgery (pre-op drainage in hilar cholangiocarcinoma)
• Palliation in unresectable tumors

Types of Biliary Stents

Type	Features
Plastic stents	• Straight or pigtail.
• Short-term use (3–6 months).
• Cheaper, easily exchangeable.
• Used in benign strictures and temporary drainage.
Self-expanding metallic stents (SEMS)	• Bare or covered.
• Larger diameter, longer patency (6–12 months or more).
• More expensive, difficult to remove.
• Preferred for malignant obstruction (palliation).
Drug-eluting stents (emerging)	Deliver chemotherapy agents (under evaluation).

Routes of Placement

Endoscopic (ERCP-guided): first-line if anatomy permits.
Percutaneous (via PTBD): used when ERCP fails or post-surgical anatomy altered.
Surgical: less common now, reserved for specific cases.

Technique (Percutaneous route overview)

Access: Puncture intrahepatic duct (US/fluoroscopy guided).
Cholangiography: Defines level and length of obstruction.
Guidewire passage: Across stricture into duodenum.
Pre-dilatation: Balloon dilatation in strictures (esp. benign).
Stent deployment: Plastic or metallic stent placed across lesion.
Confirmation: Contrast injection to confirm flow into duodenum.