a basket or balloon permits the removal of stones up to 2 cm in diameter
the bile duct can be cleared in 80% of patients
sphincterotomy enlarges the lumen of the ampulla and facilitates the spontaneous passage of gallstones
dilatation of benign biliary strictures
stenting:
indicated for palliation of bile obstruction in malignant disease
stenting involves the passage of a guide wire, followed by a cannula
the stent is 'railroaded' over the cannula
symptoms such as pruritus usually resolve within 12 hr but jaundice takes longer to improve
plastic stents become clogged with bilirubin pigment and may need changing after an average of 4 months; expensive, self-expanding metal stents probably last longer
stenting is successful in about 70% of patients with cancer of the head of the pancreas, where an open operation previously had a 10-30% mortality within 30 days of surgery
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