| [ Summary ] |
Endoprosthesis with the use of self-expandable metallic stents has become the treatment of choice because of the feasibility of inserting them through a small catheter and a considerably long patency period, after deployment, owing to their large internal diameter. Intrahepatic bile duct punctures at the site sufficiently separated from the proximal end of the stricture facilitate the subsequent insertion and deployment of the stent. Pre-procedural assessment of the biliary anatomy with noninvasive imaging tools is mandatory to select the puncture site. Traversing the stricture with a guidewire, using the catheter-guidewire technique, forms the basis for successful stent placement, but may become technically demanding. In difficult cases of tight, irregular strictures, use of a guidewire made of different materials or shape may facilitate steering movement of the tip, rendering negotiation of the stricture feasible. Self-expandable metallic stents with different designs and characteristics (e.g.,rigidity, flexibility) are currently available. The selection of the stent should be made on an individual patient basis, according to the site and configuration of the stricture(s) . Stent occlusion due to in or overgrowth of the tumor is a major complication, and insertion of an additional stent inside the pre-positioned stent (stent-in-stent placement) has become a common solution. |