BackTable / VI / Topic / Procedure

Biliary Stent Placement

Biliary Stent Placement Procedure Prep

Learn more on the BackTable VI Podcast

BackTable is a knowledge resource for physicians by physicians. Get practical advice on Biliary Stent Placement and how to build your practice by listening to the BackTable VI Podcast, reading exclusing BackTable Articles, and following the work of our Contributors.

Ep 128 From Gadgeteer to the Boardroom: Device Innovation with IR and CMO Dr. Atul Gupta with Dr. Atul Gupta
00:00 / 01:04
BackTable CMEfy button

Stay Up To Date

Follow:

Subscribe:

Sign Up:

Pre-Procedure Prep

Indications

• Primarily obstructive lesions not amenable to surgery
• Often times for palliation
• Improve liver function so patient can undergo chemotherapy
• Stents generally remain patent for longer than patient's life expectancy

Contraindications

• Coagulopathy
• Some lesions not amenable to stenting
• Hilar obstruction can pose technical challenge

Antibiotics

• Many operator give antibiotics prior to biliary stenting
• No consensus on whether to give antibiotics or which antibiotic to administer
• Piperacillin/tazobactam (Zosyn)
• 1 g ceftriaxone
• If PCN allergy, consider vancomycin or clindamycin

Biliary Stent Placement Podcasts

Listen to leading physicians discuss biliary stent placement on the BackTable VI Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.

Procedure Steps

Antibiotic Prophylaxis

• Many operators administer antibiotics prior to biliary stenting
SIR guidelines recommend antibiotic prophylaxis for PTC and routine exchanges
• 1 g ceftriaxone IV; (ii)
• 1.5 - 3 g ampicillin/sulbactam (Unasyn) IV
• Vancomycin or clindamycin for PCN allergy

Types of Stents

• Bare self-expandable metallic stents (SEMS): permanent. Made of nitinol or stainless steel
• Covered biliary stents: removable. Tubular mesh which does not endothelialize

Procedure Goal

Goal is to drain as much of liver volume as possible
Attempt to drain 50% or more of liver volume

Procedure Steps

Obtain access beyond stricture/occlusion
Position catheter within duodenum - inject to confirm position

Place sheath large enough to accomodate stent
• Consider upsizing sheath one French size
• Helpful to have option for injection around stent to identify proximal landing zone
• Also consider CO2 if stent is near occlusive within the sheath
• Helpful to use marking pigtail catheter for injection to determine length of stenosis and stent length
Place guidewire (Amplatz useful) across stenosis into bowel
Consider pre-dilation of the stricture

Stent Placement

• Choose landing zone with ~2 cm proximal and distal to the stenosis
• Depending on stenosis, distal landing zone may be beyond ampulla in small bowel.
• Details of deployment will vary with each stent
• Maintain back tension on stent as they have tendency to migrate forward during deployment

Following successful deployment, inject contrast to confirm stent patency and position
Many operators will leave "safety" pigtail biliary drain within intrahepatic system following stent procedure
• Preserves biliary access
• Maximizes biliary drainage following procedure which may help reduce chance of sepsis
• Allows for capping trial after stenting: drains commonly capped next day if patient progressing well
• Following successful capping trial (duration operator dependent - between 1-5 days), remove drain
• Some operators will inject biliary drain final time to confirm stent patency and remove "safety" drain over-the-wire

Post-Procedure

Post-Procedural Care

• Depends on specifics of patient and procedure
• Many patients can be discharged same day following stenting if previous biliary drain was present and "safety" drain left within intrahepatic ducts
• Consider IV hydration

Complications:

• Biliary sepsis
• Hemorrhage: hemobilia, pseudoaneurysm, hematoma
• Stent occlusion: tumor ingrowth or external compression
• Stent migration

Follow-Up

• Biliary sepsis
• Hemorrhage: hemobilia, pseudoaneurysm, hematoma
• Stent occlusion: tumor ingrowth or external compression
• Stent migration

Biliary Stent Placement Demos

Watch video walkthroughs of biliary stent placement on the BackTable VI expanded content network.

References

[1] Kapoor BS, Mauri G, Lorenz JM. Management of Biliary Strictures: State-of-the-Art Review. Radiology. 2018;289(3):590‐603. doi:10.1148/radiol.2018172424
[2] Chehab MA, Thakor AS, Tulin-Silver S, et al. Adult and Pediatric Antibiotic Prophylaxis during Vascular and IR Procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol. 2018;29(11):1483‐1501.e2. doi:10.1016/j.jvir.2018.06.007
[3] Ahmed O, Mathevosian S, Arslan B. Biliary Interventions: Tools and Techniques of the Trade, Access, Cholangiography, Biopsy, Cholangioscopy, Cholangioplasty, Stenting, Stone Extraction, and Brachytherapy. Semin Intervent Radiol. 2016;33(4):283‐290. doi:10.1055/s-0036-1592327
[4] Tsetis D, Krokidis Μ, Negru D, Prassopoulos P. Malignant biliary obstruction: the current role of interventional radiology. Ann Gastroenterol. 2016;29(1):33-6.
[5] George C, Byass OR, Cast JE. Interventional radiology in the management of malignant biliary obstruction. World J Gastrointest Oncol. 2010;2(3):146‐150. doi:10.4251/wjgo.v2.i3.146
[6] Inal M, Akgül E, Aksungur E, Seydaoğlu G. Percutaneous placement of biliary metallic stents in patients with malignant hilar obstruction: unilobar versus bilobar drainage. J Vasc Interv Radiol. 2003;14(11):1409‐1416. doi:10.1097/01.rvi.0000096762.74047.a6

Disclaimer: The Materials available on https://www.BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

Earn CME When You Listen to BackTable CMEfy

Podcasts

New Tools to Treat Severe Distal Femoropopliteal Disease with Dr. John Rundback on the BackTable VI Podcast)

Articles

Contributors

Related Topics