Biliary stent placement in obstructive jaundice

OCCLUSION WRAPPED Ğ I (OBSTRUCTION I F I KTER) NED I R?

Normally, about 1 liter of bile is produced daily in the liver. This bile comes to the gallbladder through the biliary tract. After condensing in the gallbladder, it proceeds through the channel called the common bile duct and flows into the duodenum. Thus, it is possible to digest the food we take.

As a result of the obstruction of this bile flow from the liver to the intestine at any level, bile cannot flow into the intestine. This is called obstructive jaundice (obstructive icterus). It is not contagious.

OCCLUSION WRAPPED Ğ THE REASONS I NELERD I R?

The most common cause in adults is gallstones. Then tumors (biliary tract cancer, gallbladder cancer, pancreatic cancer, metastatic cancers etc.) come. Scar tissue formation in previous biliary tract surgeries is another common cause.

OCCLUSION WRAPPED Ğ IN WAIST I RT I LER I NELERD I R?

In biliary system obstruction, the patient’s eye whites and skin become yellow. The color of the urine darkens, the color of the stool becomes lighter. There may be itching of the skin. Later, when the bile becomes inflamed, abdominal pain occurs with fever, chills and chills.

OCCLUSION WRAPPED Ğ I TE S H I S I HOW TO PUT?

Jaundice (bilirubin) values ​​increased in blood tests. Liver enzymes are elevated. In this case, imaging is performed for the liver and biliary system. Methods such as ultrasonography (US), Computed Tomography (CT), Magnetic Resonance (MR) are performed and the cause of the obstruction is tried to be determined. Apart from this, the inside of the bile ducts can be filled with a dyed drug and the film can be taken. This film can be made either endoscopically (by entering with a light camera through the mouth) or percutaneously (by entering through the skin with a thin needle). Generally, if the level of obstruction is in the upper part of the bile ducts, the percutaneous route is used, and in the lower part, the endoscopic method is used.

OCCLUSION WRAPPED Ğ ININ TREATMENT I S I NED I R?

If the obstruction is due to the stone, the treatment method is chosen depending on the size, number, location of the stone and the general condition of the patient. If there is a stone in the gallbladder, the gallbladder is surgically removed. If the gallstone has fallen into the bile duct, the stone is removed endoscopically. In some cases, it is possible to break or remove the stone by percutaneous way (with a needle through the skin).

If the cause of the obstruction is tumor (cancer), the definitive treatment is surgery. However, in 90-95% of the patients who apply to the physician with obstructive jaundice, the surgery phase is unfortunately passed. For this reason, unfortunately, it is not possible for patients to undergo surgery. In this case, the “flow of bile into the intestine” is targeted as a treatment. A bile stent is used to achieve this. A metal cage or plastic tube called a stent is placed into the clogged bile duct, allowing the bile to flow into the intestine.

Bile stents are of two types, metal or plastic. Metal stents are approximately 1 centimeter wide when opened. They are inserted into the bile duct closed and open when inside. Percutaneously placed stents are of this type. In addition, plastic stents are mostly placed endoscopically and the inner diameter through which bile flows is 3-4 times narrower than metal stents, and they become occluded quickly. For this reason, metal stents are preferred. However, metal stents are quite expensive compared to plastic stents.

OCCLUSION WRAPPED Ğ INDA BALANCE STENT I HOW TO ATTACH?

A metallic bile stent is inserted percutaneously (through the skin with a needle) by the Interventional Radiology Specialist. In the angiography device, the procedure is performed after the patient is given intravenous anesthetics and pain relievers. This procedure called “Percutaneous Transhepatic Stent Cholangioplasty” has 3 or 4 steps.

Percutaneous Transhepatic Cholangiography (PTC) : The enlarged bile duct in the liver is entered with a thin needle between the ribs on the right side of the patient’s abdomen. A film of the biliary tract is taken by giving a dyed drug with a needle. This is called Percutaneous Transhepatic Cholangiography (PTC). Here, the cause of the obstruction is determined and the extent of the disease (tumor) is seen.

Place Percutaneous Biliary (Biliary) Stent s squeaking: A thin wire is passed beyond the stenosis or obstruction in the biliary tract and the intestine is accessed. The stent (wire cage) is inserted over this wire until the stenosis is placed at the level of the stenosis and the stent is opened.

Percutaneous Balloon Dilation: It is the expansion process by inflating the balloon in the stent in cases where the placed stent cannot completely open the tumor-related stenosis. Often, stent deployment becomes 100% after balloon dilation.

Percutaneous Biliary Drainage:Place stent

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