Topic: why remove the biliary stent?

My mother was diagnosed about a month ago with biliary and possibly pancreatic cancer. Because of her bad condition at the time she went into the hospital, they inserted a biliary stent, by way of her esophagus (forgetting the proper term right now). It worked well and she is now stable.

The doctors have not been very forthcoming with information to my mother and sister (they live a bit away and I am not there for doctor visits, etc). Anyway, mother is now home and there is no chemo or actual surgery planned yet if any will be. But they want her to come in later this week to have the stent removed.  She says she doesn't want that unless they give her a GOOD reason for removing it. Says...its working, why remove it? She is afraid she will just get in the bad condition again if they remove it.  Only thing I have found that might relate is that maybe the stent might be prone to infection if left in.  Any other "common knowledge" reason for them wanting to remove it?  Of course, she needs to ask the doctors, but hoping we can get some info before then if possible, so she can understand their reasoning maybe.  Thanks for input!!

Re: why remove the biliary stent?

acountrygirltoo,
Sorry to hear of your Mom's condition.  Not knowing the exact procedure I can't be of much help to you.  The only thing I can think of is after placing the stent and reviewing, they may feel a different lenght or type would be beneficial in the long run.  It is fairly normal to have stents changed every 2-3 months to prevent clogging and infections.  Some people start out with plastic stents and then end up changing and having metal stents which are easier to keep unclogged with out having to change.  I'm sure other on this site will respond to your post who are actually doing very well with stents.  This is just infor i've read from other members on this site.  I personally have not needed a stent as of yet.
Wish your Mom the best and remember a second opinion is always a good Idea in my book.
God Bless,
Jeff G.

Take it to the Limit,One More Time! (Eagles)

Re: why remove the biliary stent?

acountrygirltoo, I agree with JeffG (I almost always do, he is filled with knowledge and wisdom!).  I just had the same thing happen and I am wondering if it is the same case as your mom.  The name of the procedure your mom probably had was an ERCP, they take a lighted scope and go through the mouth, down the esophagus, etc etc.  The stent is placed (or removed) through this same lighted tube.  And, as Jeff said, it is quite common for us ccc'ers.  Lucky me, I had the procedure THE DAY BEFORE I left on a cruise, how's that for luck!

Anyway, here are some questions to ask your mother's doctor.  Do they want to remove the stent so they can replace it with a new one?  are here liver tests indicating a blockage?  Ask your sister, is your mother jaundiced (yellow)? which would be a sign of a blocked stent. 

I never make assumptions, you indicate that your mother and sister did not get the right information.  Does your sister go to your appointments with your mother?  If so, this is what I recommend they do.  Write down all of the questions that you all have about the stent, chemo, etc etc, then bring that piece of paper to the doctor appointment.  So, for example:

you say you want to remove my mother's stent, will you be replacing it with a new one?  plastic or metal?  why (for which)

if you are not planning on replacing it, why not?

What signs or symptoms does my mother exhibit that warrant her going through the procedure?  are her liver enzymes elevated, is she jaundiced?

get the picture?  Oh, one last thing, don't leave until the rushing sound in your ears goes away and you truly hear and understand what the doctor says.  So often what you hear is "blah blah blah cancer, blah blah, no, blah blah blah, chemo, blah blah blah, stent, blah blah blah blah, have a nice day"

good luck!

Barb

Re: why remove the biliary stent?

My Mom has a plastic stent in, which I understand is temporary, maybe 2-3 months before needing replacement.  Odd thing is, she has just spent her 5th day in the hospital with a Klebsiella bacterial blood infection. Her oncologist says the stent may be the source of the infection.  She had it placed via endoscope as mentioned by Senior Member 'the cdr' about 1 month ago.  Severe chills were the symptom of the blood infection.  She is getting better with IV Cefapim antibiotics.  Hopefully will get better enough to continue on with the chemo.  Hoping for more months to spend with her. Candee

Re: why remove the biliary stent?

Hi Candee,   Sorry about your Mom getting an infection and hope it is cleared up soon.  It is so often I read about infections involving stents.  I'm trying to determine in my own mind , what percentage of these infection are due to lack of proper sterile conditions and the body immune system rejecting the placements.  I have noticed individuals with metal stents seem to do some what better. Just thinking out loud.  Wish you and your Mom the best.
Bless Ya!
Jeff G.

Take it to the Limit,One More Time! (Eagles)

Re: why remove the biliary stent?

whether plastic or metal remember that either one can become blocked if you have tumor growinge over it (as in my case).  I think you will hear arguments for either side depending on who your doctor is, or maybe what his specialty is.  My GI swears by plastic, my Liver guy swears by metal, who knows

7 (edited by marions Mon, 07 Jan 2008 18:52:12)

Re: why remove the biliary stent?

Candee,
This is what I have learned:   Plastic stents will have to be replaced as frequently as every three months and as it was in our case, the replacement was always necessitated due to a bilary infection.
The metal stent is larger in diameter and therefore allows for a greater bilary flow however, if a resection is contemplated for the patient in the future, a metal stent could present itself to be a problem as it cannot be removed from the patient

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: why remove the biliary stent?

Marions,
I am glad you mention this re: metal vs plastic stents. My father has had to have his plastic stent changed about every 6-9 weeks. This last visit the Dr. at Mayo clinic wanted him to have a metal stent. He met with surgeon and has decided to undergo surgical resection. Surgeon said do not have a metal stent.
Thanks again for the post,
Lana

Re: why remove the biliary stent?

My husband started out with the external plastic stents, but because of continuing infections they were replacing them every 3-4 weeks. Shortly thereafter Nov. 2006 we went to Mayo in AZ. they replaced them with internal metal stents. Since then they have blocked twice and the radiology intervention have gone back in with a balloon to dilate the area around the stents and allow for drainage.  The metal stents cannot be removed. The Dr. said if he gets more blockage it might be necessary to put in an additional stent to allow for more drainage.
Irene

Re: why remove the biliary stent?

Lana,
Our surgeon although, hesitant due to the metal stent still went ahead with the resection.  We were lucky as the stent had been placed 4 weeks prior to the surgery and the tumor had not yet invaved the stent.  According to this surgeon removal of a metal stent is rarely possible and very time consuming as every little piece of metal will have to be retrieved.   
Marions

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: why remove the biliary stent?

Hi - my dad has two metal stents, the first was introduced in June 2006 and the second in April 2007. So far the second one seems to have been working OK but when he only had one he had two major infections from blockage. Fortunately the blocking was not due to tumoral growth but the speed with which the infection spread was astonishing. The first infection almost took dad literally in 24 hours and once he recovered he still had two major cysts in the liver (these probably caused the second infection)

Dad now regularly monitors his liver function and particularly alkaline phosphatase as a measure for blockage. I think he's due for a check up on the second stent which i hope can be more easily replaced since it's a derivation.

Hope it helps.

Best of luck to everyone.

Amilcar

12 (edited by JeffG Tue, 08 Jan 2008 12:34:31)

Re: why remove the biliary stent?

Site Members,
Metal vs Plastic stents...... I just finished reading 17 studies that have been
conducted on stents.  It is amazing how much information there is as far as comparability of effectiveness.  Also different types of metal and plastic stents.  Also I discovered that metal stents can be replaced as well as being unclogged with a balloon type rotter rooter.  There is also different types of metal stents to include polymer coated to help preveny tumor invasion as quickly.  I also learned that they can even place plastic stents within the metal stents.  After reading all these studies it boiled down to  little to no difference with the exception that plastic stents were easier to replace and less expensive than platinum stents.  The primary concern was age, location, aggressiveness of tumor causing blockage in both types from the direction of the bile flow and of course infection once bile flow begins to restrict.  Overall it falls back to the individual and how advance and aggressive their disease is.  When it came to prolonging life the metal stents came out on top by only a small margin (3 percent)  according to one study I read.  If you just do a search (metal stents vs plastic stents), you will get plenty of information to digest , including vivid pictures of stents being placed and cleaned out.  I wanted to bring this infor to everyones attention so you may make a well informed choice and that second opinions apply to the type of stents due to so many factors involved.  As with having a resection, there will be difference of opinion between doctors. We have to remember to advocate what is best for you and your body.  That comes from knowledge of subject and challenging your professionals with approriate questions and then do your own comparison of your situation.  I think I have got to take a nap now.  Wish you all the best.
God Bless !
Jeff G.   P.S. I think I'll visit Subway before the nap. My hunger outways my tiredness.

Take it to the Limit,One More Time! (Eagles)

Re: why remove the biliary stent?

Jeff,

Thanks for looking into this matter so thoroughly.

G