Jaundice from pancreatic cancer
- This 74 year old lady was deeply jaundiced (yellow), nauseated and had lost a significant amount of weight.
- Her imaging and bloods were concerning for a pancreatic cancer.
- At Endoscopic Retrograde Cholangiopancreatography (ERCP) a significant narrowing was noted at the end of the bile duct.
- This was biopsied and brushed.
- The results confirmed pancreatic cancer.
- An uncovered metal stent was inserted through the stricture and pus came shooting out.
- Biliary stents are commonly used in patients with primary pancreatico-biliary malignancy, metastatic disease and external biliary compression by lymph nodes.
- By providing biliary decompression they can relieve jaundice and pruritus, while minimising the risk of developing cholangitis, as was seen in this patient were a developing local infection was drained.
- Biliary stenting has broad uses in the setting of malignant pancreatico-biliary disease. It is used both as a bridge to surgery in patients with resectable disease, and for palliation in patients with biliary obstruction in the setting of unresectable disease.
- A variety of plastic and metal stents, both covered and uncovered, are commercially available. No specific stent has been identified as ideal for all patients.
- Whilst plastic stents are inexpensive and effective and can be easily removed or exchanged, they eventually become occluded.
- Metal stents extend the duration of stent patency, but are more expensive and may not be removable.