47801 Placement of choledochal stent

Name of the Procedure:

Placement of Choledochal Stent
Common Names: Biliary Stent Placement, Choledochal Stenting
Medical Term: Endoscopic Biliary Stent Placement

Summary

Placement of a choledochal stent is a medical procedure in which a tiny tube (stent) is inserted into the bile duct to relieve blockages and allow bile to flow from the liver to the small intestine.

Purpose

This procedure addresses conditions like bile duct obstruction caused by gallstones, tumors, or strictures. The goal is to restore proper bile flow, relieve symptoms like jaundice and pain, and prevent further liver damage.

Indications

• Obstructive jaundice
• Biliary strictures
• Bile duct stones
• Pancreatic or bile duct tumors
• Post-operative bile duct injuries

Preparation

• Fasting for at least 6 hours before the procedure
• Adjustment or discontinuation of certain medications (e.g., blood thinners)
• Pre-procedure imaging tests (e.g., ultrasound, CT scan)
• Blood tests to check clotting function and liver enzymes

Procedure Description

1. The patient is given sedation or anesthesia.
2. An endoscope (a thin, flexible tube with a camera) is inserted through the mouth, passing through the stomach into the duodenum.
3. A contrast dye is injected to visualize the bile ducts on X-ray.
4. A guidewire is passed through the blockage in the bile duct.
5. The stent is placed over the guidewire and positioned within the bile duct to keep it open.
6. The endoscope is removed, and the stent remains in place.

Duration

Typically, the procedure takes about 1 to 2 hours.

Setting

Performed in a hospital endoscopy suite or a specialized outpatient surgical center.

Personnel

• Gastroenterologist or surgeon
• Anesthesiologist or nurse anesthetist
• Endoscopy nurses and technicians

Risks and Complications

• Infection (cholangitis)
• Pancreatitis
• Bleeding
• Perforation of the bile duct or intestine
• Stent migration or blockage
• Rarely, allergic reaction to contrast dye

Benefits

• Rapid relief of symptoms like jaundice and abdominal pain
• Prevention of further liver damage
• Improved quality of life
• Stabilization of bile flow

Recovery

• Patients are usually monitored for a few hours post-procedure.
• Instructions may include rest, avoiding heavy lifting, and adhering to dietary recommendations.
• Follow-up appointments to monitor the stent and address any complications.
• Most patients can resume normal activities within a few days.

Alternatives

• Percutaneous transhepatic biliary drainage (PTBD)
• Surgical biliary bypass
• Non-interventional management (with appropriate medication and observation)

Pros and Cons:

• PTBD can be an option if endoscopic approach is not feasible but involves percutaneous access.
• Surgical bypass is more invasive but may provide a permanent solution.
• Non-interventional management lacks immediate relief and may not address the underlying cause.

Patient Experience

• During the procedure, the patient might feel some pressure or discomfort due to the endoscope.
• Post-procedure, mild sore throat from the endoscope insertion is common.
• Pain management includes medications as prescribed by the doctor.
• Most patients experience significant relief from jaundice and pain within a few days.