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
Common Name(s): Biliary Stent Placement, Percutaneous Biliary Stenting
Summary
This procedure involves inserting a stent (a small tube) into the bile duct through the skin to keep it open. This technique also includes diagnostic cholangiography (imaging of bile ducts), guiding the procedure with fluoroscopy and/or ultrasound, and may involve balloon dilation, catheter exchanges, and catheter removal as needed.
Purpose
Medical Condition or Problem Addressed:
This procedure treats bile duct obstructions, which can be caused by conditions like tumors, gallstones, or strictures.
Goals or Expected Outcomes:
The aim is to relieve bile duct obstruction, improve bile flow, alleviate jaundice, and reduce associated symptoms or complications.
Indications
Specific Symptoms or Conditions:
- Jaundice (yellowing of the skin and eyes)
- Biliary stricture (narrowing of the bile ducts)
- Bile duct tumors or blockages
- Post-surgical bile leaks
Patient Criteria:
- Patients with obstructed or narrowed bile ducts
- Individuals who are unsuitable for surgical bile duct interventions
Preparation
Pre-procedure Instructions:
- Fast for 6-8 hours before the procedure.
- Adjust medications as instructed by your doctor, especially blood thinners.
- Complete any required blood tests or imaging studies.
Diagnostic Tests or Assessments:
- Blood tests (liver function tests)
- Imaging studies (ultrasound, CT scan, or MRI)
Procedure Description
Steps Involved:
- Anesthesia: Local anesthesia and sedation are typically administered.
- Imaging Guidance: Fluoroscopy and/or ultrasound are employed to guide the placement.
- Cholangiography: Diagnostic imaging of the bile ducts is carried out.
- Needle Insertion: A needle is inserted through the skin into the bile duct.
- Guidewire Placement: A guidewire is passed through the needle into the bile duct.
- Stent Insertion: A stent is navigated over the guidewire into the narrowed or blocked area.
- Balloon Dilation: A balloon catheter may be used to expand the stent or dilate the duct.
- Catheter Management: Catheter exchanges or removals can be performed as required.
Tools, Equipment, Technology:
- Needles, guidewires, stents, balloon catheters
- Fluoroscopy and ultrasound equipment
Anesthesia or Sedation:
- Local anesthesia with sedation is commonly used.
Duration
Typically, the procedure takes about 1-2 hours.
Setting
The procedure is performed in a hospital's interventional radiology suite or a specialized outpatient clinic.
Personnel
- Interventional radiologist
- Nurses
- Anesthesia personnel
Risks and Complications
Common Risks:
- Infection
- Bleeding
- Pain at the insertion site
Possible Complications:
- Perforation of the bile duct
- Migration or blockage of the stent
- Pancreatitis
- Allergic reaction to contrast dye
Benefits
Expected Benefits:
- Immediate relief from bile duct obstruction
- Reduction in jaundice and related symptoms
- Improved liver function
Realization Timeline:
Benefits are typically noticed within a few days following the procedure.
Recovery
Post-procedure Care:
- Monitor the insertion site for signs of infection.
- Follow specific dietary instructions.
- Take prescribed antibiotics or pain medications as directed.
Expected Recovery Time:
Recovery usually takes about 1-2 weeks. Some patients may resume normal activities within a few days.
Restrictions and Follow-up:
- Avoid heavy lifting and strenuous activities for a few days.
- Schedule follow-up appointments to monitor the stent's position and function.
Alternatives
Other Treatment Options:
- Endoscopic Retrograde Cholangiopancreatography (ERCP) with stent placement
- Surgical intervention
Pros and Cons of Alternatives:
- ERCP: Minimally invasive but may not be suitable for all patients.
- Surgery: Effective but involves more risk and longer recovery.
Patient Experience
During the Procedure:
- Mild discomfort at the insertion site.
- Sedation helps to ensure comfort during the procedure.
After the Procedure:
- Some soreness or bruising at the insertion site.
- Pain management through prescribed medications, if needed.
- General well-being improvements as bile flow is restored within days.