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.
