History of Bile Duct Stenting: Rigid Prostheses

Malignant obstructive jaundice caused by tumor obstruction at the head of pancreas, peri-ampullary area, bile duct or gall bladder, and hilar lymphadenopathy carries considerable morbidity and mortality (Fig. 2.1a, b ). Biliary obstruction can lead to severe itching, and prolonged obstruction leads to impaired immune (both humoral and cellular) defense mechanisms predisposing the patient to increased risk of infection, endotoxemia, coagulopathy, impaired vascular response with acute renal failure, bleeding, wound sepsis, and impaired wound healing [ 1– 13 ] . Various imaging modalities have evolved over time to de fi ne the exact level and nature of bile duct obstruction. In addition, the advent of needle aspiration and biopsy allows nonoperative tissue sampling to help discern the underlying cause of malignant biliary obstruction. Surgery is the only hope of cure for many of these patients, but for those with unresectable lesions, direct cholangiography via ERCP [ 14 ] and percutaneous transhepatic access [ 15 ] provides imaging as well as access to the biliary system for decompression and palliative drainage. Over the past several decades, we have seen the evolution and development of different biliary stent technologies with improved plastic stents and stent deployment systems as well as the introduction of self-expandable metal stents (SEMS). This chapter will discuss the development of plastic biliary stents for the management of bile duct obstruction. As noted above, stents were originally developed for the palliative treatment of malignant obstructive jaundice. Currently, indications for the use of plastic biliary stents have widened to include the treatment of patients with numerous benign biliary processes, such as large bile duct stones and benign bile duct strictures.