47538 Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiologica

Name of the Procedure:

Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (e.g., fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s), and catheter removal(s) when performed, and all associated radiologic guidance.

Summary:

This procedure involves inserting a tiny mesh tube called a stent into the bile duct via a small needle puncture to relieve blockages or narrowing. Diagnostic imaging helps guide the stent placement. Sometimes, the bile duct may also be widened using a balloon and catheters may be exchanged or removed.

Purpose:

The primary aim of this procedure is to relieve blockages in the bile duct, which can be caused by conditions such as tumors, gallstones, or scarring. The expected outcome is improved bile flow from the liver to the intestine, reduction of jaundice, and relief of associated symptoms.

Indications:

• Obstruction of the bile duct due to tumors or gallstones.
• Narrowing or strictures of the bile duct.
• Jaundice caused by bile duct issues.
• Infections in the bile duct (cholangitis).

Preparation:

• Fasting for at least 6-8 hours prior to the procedure.
• Medication adjustments, particularly blood thinners, as advised by the healthcare provider.
• Blood tests and imaging studies like ultrasound or MRI to assess the bile duct.

Procedure Description:

1. The patient lies on an X-ray table.
2. An intravenous (IV) line is inserted for sedation or anesthesia.
3. The skin over the liver is cleaned and numbed with local anesthesia.
4. A small needle punctures the skin and a guidewire is inserted into the bile duct.
5. Using fluoroscopy or ultrasound, a contrast dye is injected to visualize the bile ducts (cholangiography).
6. A balloon may be inflated to dilate the bile duct if needed.
7. A stent is threaded over the guidewire and positioned within the bile duct.
8. The stent is deployed, allowing bile to flow through the duct.
9. Catheter exchanges or removals are performed if necessary.

10. Radiologic imaging verifies the placement.

    Duration:

    The procedure typically takes 1 to 2 hours.

Setting:

The procedure is usually performed in a hospital's interventional radiology or surgical suite.

Personnel:

• Interventional radiologist or a specially trained surgeon.
• Nurses.
• Anesthesiologist or sedation nurse.

Risks and Complications:

• Infection at the puncture site.
• Bleeding.
• Pancreatitis.
• Displacement or blockage of the stent.
• Allergic reaction to the contrast dye.

Benefits:

• Relief from symptoms associated with bile duct obstruction.
• Improved liver function and bile flow.
• Reduced jaundice and infection risk.
• Potentially quick symptomatic relief within days.

Recovery:

• Monitoring in a recovery area for several hours.
• Instructions for wound care and activity limitations.
• Follow-up imaging studies to check stent position.
• Pain management as advised by the healthcare provider.
• Avoiding heavy lifting or strenuous activities for a designated period.

Alternatives:

• Endoscopic stent placement (ERCP).
• Surgical biliary bypass.
• Medication to manage symptoms.
• Observation if the condition is mild.

Patient Experience:

During the procedure, the patient may feel discomfort or pressure but should not experience pain due to sedation. Post-procedure, there may be soreness at the puncture site, and mild pain as the body adjusts. Pain medication and comfort measures will be provided as required.