Stents for jaundice in pancreatic cancer

Pancreatic cancer can sometimes cause pressure on the bile duct and block it. This causes jaundice, which can cause

• Yellowing or darkening of the skin and whites of your eyes
• Feeling sick
• Darkened urine
• Itching
• Lethargy and tiredness

Your doctor is most likely to suggest putting a tube called a stent into the bile duct or top of the small bowel (duodenum). The stent allows the bile to flow into the bowel again and reduces the symptoms of jaundice. Having a stent put in is generally a simple procedure that you can have done with either local anaesthetic or a sedative. 

Stents can block after a few months and may need to be replaced. If the stent does not work for any reason, your specialist may suggest bypass surgery to relieve jaundice. This is quite a major operation.

If your doctor suggests major surgery, you may want to talk this over fully with your doctor and nurse as well as with your close family and friends. No one can say how much you will benefit from the operation. It is likely to be quite a big operation and just when you are feeling very low. But you may make a good recovery and feel better for longer if you do have the surgery.

There is detailed information about these operations in the CancerHelp UK section on surgery to relieve symptoms of pancreatic cancer. There is also information about surgery to bypass a blockage in your digestive system caused by your cancer. Instead of surgery, it is possible to have drug treatment to relieve a blockage in your digestive system.

A stent is a small plastic or metal tube put inside the bile duct or top of the small bowel (duodenum) to keep it open. There are two ways of having a stent put in - stenting using endoscopy and putting a stent in through the skin.

For either of these procedures, you will be asked not to eat or drink for six hours beforehand so that your stomach and upper bowel are empty. But you will not need a general anaesthetic. You can have these procedures with just a sedative, to relax you. 

Stenting using endoscopy means that the doctor puts a flexible tube called an endoscope into your mouth and passes it down your throat to your stomach. The doctor can see inside your body using the eye piece at the top of the tube or by watching a screen. The doctor passes the endoscope tube all the way down through your stomach to your duodenum until it reaches the opening of your bile duct. Once it is in place, the doctor injects dye into the bile duct and uses an X-ray to watch the flow of the dye and see where the duct is blocked. Once the doctor has found the blockage, they can stretch the duct and put the stent in place.

Putting a stent in through the skin is sometimes called 'percutaneous transhepatic cholangiography'. You have a local anaesthetic to numb the area where the needle is to go in. Dye is used to show up the bile duct and blockage. Then, the doctor puts a needle attached to a wire through the skin and moves it carefully into position inside the bile duct. The X-ray helps the doctor to see where to put the wire. Once the wire is in place, the doctor feeds the tube along the wire until it is in place inside the bile duct. Then the doctor can pull out the wire.

After a stent procedure, you will need to recover from the sedative. Your doctor may want you to stay in hospital overnight so the nurses can keep an eye on you while you recover.

There are not really very many side effects from having a stent put in. You may need to take antibiotics for a few days afterwards, to prevent any infection from developing. You are at risk of infection while you have the stent in place because bacteria from the gut can travel up the stent to the gall bladder. If you have signs of infection, such as a high temperature and shivering, at any time while the stent is in place you should contact your doctor straight away. You may need to go into hospital for antibiotic treatment.

A stent should keep the bile duct open and stop bile building up and causing jaundice. You should notice the benefit within a day or two of having your stent put in. Unfortunately, stents can become blocked after a few months. If necessary, your stent can be replaced by the same method as before.