Find out about stents to relieve symptoms in advanced bile duct cancer (cholangiocarcinoma).
What is a stent?
A stent is a small flexible plastic or metal tube. Doctors use stents to open up a blockage caused by the cancer. This helps to relieve symptoms caused by the blockage.
A blocked bile duct
Advanced bile duct cancer (cholangiocarcinoma) can block the bile duct. This causes jaundice, which can have the following effects:
- yellowing or darkening of the skin and whites of your eyes
- feeling sick
- loss of appetite
- darkened urine
- pale coloured poo (stools)
- feeling weak and tired
Putting a stent into the bile duct means that bile can flow into the small bowel again. You usually notice the benefit within a day or two of having your stent put in.
A blocked bowel
Some people with distal bile duct cancer have a blockage where the stomach joins the small bowel (the duodenum). This can stop the stomach emptying. The symptoms include feeling and being sick.
A stent might help to keep the duodenum open. This should give you relief from being sick, and so you might feel like eating again.
Your doctor may put a stent into the bile duct at the same time as the duodenum.
Having a stent
You can't eat for 6 hours before having a stent put in. This is to make sure that your stomach and upper bowel are empty. You can usually drink water up to 2 hours beforehand.
You have the procedure in the x-ray department. It can take up to 1 to 2 hours.
You have a drug that makes you sleepy and relaxes you before the procedure. This is called a sedative.
Putting in a stent using endoscopy
You usually have a stent put in during a procedure called an ERCP. Your doctor puts a flexible tube called an endoscope into your mouth and passes it down your throat to your stomach and into the small bowel (duodenum).
The endoscope has a camera on the end of it. Your doctor watches the images on a TV screen.
To find a blockage in the bile duct, your doctor injects dye into the bile ducts. They use x-rays to watch the flow of the dye to see where the blockage is. They then put the stent in position to open up the bile duct so that the bile can flow again.
If the blockage is in the duodenum, your doctor passes a very thin guide wire down the endoscope into the blockage.
They remove the endoscope and use the thin wire to guide the stent into the blockage. They then remove the wire. The stent gradually expands and opens up the blockage.
Putting a stent in through the skin
Stents can be put into your bile duct by going through your skin. This is called percutaneous transhepatic cholangiography (PTC).
You have a local anaesthetic injection into your skin above the liver to numb the area. Your doctor puts a long thin needle through the skin and liver, and into the bile ducts. You may feel a twinge when the needle goes into the liver or some discomfort around your right shoulder. They use ultrasound or x-rays to help guide the needle.
Your doctor injects some dye (contrast medium) into the bile ducts. You may have a warm sensation through your body. This is normal. The dye shows up on the x-rays, so the doctor can see where the blockage is. They put a wire down the needle into the bile duct and use it to guide the stent into place.
After having a stent
You need to recover from the sedative after the procedure. Your nurse checks your blood pressure, pulse and temperature, and makes sure you are comfortable. You might need to stay in hospital overnight.
Your nurse tells you when you can start eating and drinking. This is usually once you are fully awake and if you don’t feel sick.
After a duodenal stent you usually start with very soft moist foods. Some foods are at risk of getting stuck in the stent such as nuts and raw hard vegetables. Your nurse will give you information about this before you go home.
You might need to take antibiotics for a few days to prevent infection. Contact your doctor straight away if you have signs of infection such as a high temperature or shivering. You may need to go into hospital to have antibiotics through a drip.
Unfortunately, stents can become blocked after a few months. If necessary, your stent can be replaced in the same way as before.
If your stent doesn't work
Your doctor may suggest bypass surgery to relieve symptoms if the stent doesn’t work. This is quite a major operation and isn’t suitable for everyone. Your doctor will explain the possible risks and benefits of the operation to you and your family.