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
CPT4 code
Name of the Procedure:
Placement of Stent(s) into a Bile Duct, Percutaneous (including diagnostic cholangiography, imaging guidance, balloon dilation, catheter exchange(s), and catheter removal(s) when performed, and all associated radiological guidance)
Summary
This procedure involves inserting a tube (stent) into the bile duct through the skin to open up blockages. It uses imaging techniques like fluoroscopy and ultrasound to guide the stent into place, often along with balloon dilation to widen the bile duct. The procedure can also include changing catheters and removing them as needed.
Purpose
- Medical Condition: This procedure addresses obstructions in the bile duct, which can be caused by conditions like bile duct strictures, tumors, or gallstones.
- Goals: To relieve bile duct blockage, allowing bile to flow normally from the liver to the intestines. This helps alleviate symptoms like jaundice, itching, and abdominal pain, and prevents further complications such as infections or liver damage.
Indications
- Symptoms: Jaundice (yellowing of the skin and eyes), severe itching, abdominal pain, and dark urine.
- Conditions: Bile duct strictures, bile duct tumors, gallstones, and complications from previous surgeries.
- Patient Criteria: Often recommended for patients who have already undergone non-invasive treatments like medication without success or when immediate relief from bile duct obstruction is necessary.
Preparation
- Pre-procedure Instructions: Patients may need to fast for several hours before the procedure. Medication adjustments, such as stopping blood thinners, might be required.
- Diagnostic Tests: Blood tests, liver function tests, imaging tests like MRCP (Magnetic Resonance Cholangiopancreatography) or ERCP (Endoscopic Retrograde Cholangiopancreatography).
Procedure Description
- Sedation/Anesthesia: Local anesthesia is commonly used, sometimes with sedation to keep the patient comfortable.
- Imaging Guidance: Fluoroscopy and/or ultrasound are used to locate the bile duct accurately.
- Insertion: A needle is inserted through the skin into the bile duct.
- Cholangiography: Contrast dye is injected to visualize the bile duct and locate the blockage.
- Stent Placement: A guidewire and balloon catheter are threaded through the needle; the balloon is inflated to widen the duct, and the stent is placed to keep it open.
- Catheter Management: If necessary, catheters may be exchanged, and previous ones removed.
Duration
The procedure typically takes between 1 to 2 hours.
Setting
Performed in a hospital's radiology or interventional radiology department, sometimes in an outpatient clinic with appropriate facilities.
Personnel
- Interventional Radiologist
- Radiology Technologist
- Nursing Staff
- Anesthesiologist or Nurse Anesthetist, if sedation or general anesthesia is used
Risks and Complications
- Common: Minor bleeding, pain at the insertion site, and infection.
- Rare: Significant bleeding, bile leakage, perforation of the bile duct, and stent migration.
Benefits
- Rapid relief of symptoms like jaundice and abdominal pain.
- Improved liver function and prevention of complications related to bile duct obstruction.
- Reduction in the risk of severe infections like cholangitis.
Recovery
- Post-procedure Care: Patients may need to stay in the hospital for observation, monitoring for complications, and pain management.
- Instructions: Keep the insertion site clean, avoid strenuous activity for a specified period, and follow prescribed medications.
- Recovery Time: Initial recovery might take a few days to a week, with follow-up appointments scheduled to monitor the stent and overall health.
Alternatives
- Other Options: Endoscopic stent placement, surgical intervention, percutaneous transhepatic catheter drainage.
- Comparison: Endoscopic procedures are less invasive but might not be suitable for all patients. Surgical options are more invasive with longer recovery times.
Patient Experience
- During Procedure: Patients might feel pressure or mild discomfort, especially if they are sedated rather than under general anesthesia.
- After Procedure: Mild pain or soreness at the insertion site is common. Pain management includes medications and rest.
- Overall Comfort: Measures are taken to ensure the patient's comfort and minimize pain throughout the procedure.