ERCP and Stent Placement

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from:

http://www.gihealth.com/html/education/photo/ercpStent.html

This photo is an example of how ERCP can be used to treat an uncommon, but

major, complication of gallbladder surgery - a bile duct leak. What you see

is the end of a plastic tube called a stent which is protruding from the

bile duct from the wall of the small intestine. This stent was placed into

the leaking bile duct during ERCP. The stent bypasses the leak and allow

the bile duct to heal without the need for major surgery. Read on for a

more detailed explanation....

First some anatomy.... Your liver has many jobs to perform. One is

making bile, a bitter yellow liquid which helps the small intestine digest

your food. Bile is collected by a series of small hollow tubes called bile

ducts. These ducts come together - much like the branches of a tree - to

form a main trunk. Named the common bile duct, this trunk drains into the

intestine through a small nipple called the Ampulla of Vater. Halfway down

the main trunk is a side branch which empties into the gallbladder. Your

liver makes bile 24 hours a day. The gallbladder pouch stores and

concentrates extra liver bile between meals. When you eat, the gallbladder

contracts and bile enters the small intestine to help digest your food.

This is a the case of a 35 year old women who was admitted to the

hospital with severe abdominal pain. Three days before, her gallbladder had

been removed due to a bad case of gallstones. The operation was done by

laparoscopy, or " bandaid " surgery using three small incisions. She expected

a prompt recovery with very little pain. But after discharge from the

hospital, her pain became worse and she returned.

A emergency CT Scan x-ray demonstrated a large amount of liver bile leaking

out of the bile ducts and into the abdominal cavity. This meant that she

had an uncommon serious complication from her gallbladder surgery - a leak

had formed in one of the bile ducts and bile was spilling out into her

abdominal cavity. Within the abdominal cavity, liver bile is a very

irritating substance. It is like putting acid on an open wound.

Because of this bile leak and her recent sugery, her surgeon felt that it

would be very difficult to reoperate. Instead, Dr. Stanley was consulted

and asked to perform an ERCP procedure. By using a videoscope passed

through the mouth while the patient was sedated, he located the nipple-like

Ampulla in the wall of the upper small intestine and placed a special drain

(stent) up into the main common bile duct stopping the leak and allowing

the bile duct to heal. The procedure only took about 20 minutes. Because of

the sedation, the patient didn't feel a thing.

This photo shows the blue stent loaded onto an thin catheter which is

passed through a channel in the ERCP scope. Under direct vision on the TV

monitor, the doctor placed the stent through the ampulla and into the bile

duct. This allowed the liver bile to bypass the area of leak and drain

normally. Her pain was gone in within 24 hours and she was released. The

stent will be kept in place for about a month and then simply removed

during a second scope procedure. This is a good example of how ERCP can be

used to avoid major surgery and salvage a bad situation such as this

post-operative complication.