Methods of Prolonging Biliary Patency

Abstract

Methods of Prolonging Biliary Patency Lindsay Machan, M.D. BILIARY placement is well established as an effective treatment for obstructive jaundice when a surgical cure is not possible 0). In patients with benign biliary obstruction, permanent stent placement is controversial, but, in malignancies, is well accepted. Metallic stents appear more efficacious than plastic stents for malignant obstructions but the choice of stent should be decided on a case by case basis. Regardless of the clinical scenario and the choice of stent, stent occlusion remains the major problem facing the intelventional radiologist managing a patient with biliary obstruction. An occluded biliary stent is a contaminated foreign body that contains bacteria; recurrent biliary obstruction is, therefore, complicated by cholangitis and sepsis. Acute or chronic occlusion can occur with plastic or metallic prostheses and in each instance there are specific predisposing factors. These will be addressed separately, but common factors that influence both patency for both plastic and metallic stents are stent diameter, high gradient across the tube, and biliary rheology. Dehydration adversely affects biliary rheology and should be avoided.