SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 59 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission PA R T 6 : S T E N T S Biliary stents can be plastic or metal. Plastic stents are usually temporary and are much cheaper than metal stents so are put in place when the intention is to remove them at some point, or in certain cases they can be permanent when the patient is not expected to recover due to the severity of their disease but stenting is indicated for palliative reasons. An example of this may be advanced cancer causing jaundice and itching. There are literally dozens of different stents that are available, but as mentioned before, whilst I am open to new developments, it’s probably best to keep it simple and I doubt there is that much difference in what is essentially a tube! Plastic stents These are divided into lengths (anywhere from 5-15cm long)and width - or gauge - 5,7 or 10 French (so called because they were invented by the Frenchman Joseph-Frédéric-Benoit Charrière in Paris in the 19th century…), 5 being the narrowest. (“1 French” or 1Fr is 0.33mm diameter, so 5Fr is 1.65mm diameter, 10Fr is 3.3mm diameter and so on). This applies to hollow tubes only and is different to the measurements of the thickness of needles (yes I know they are hollow) or wires (or sheets of metal) which is the Gauge (Ga) and works backwards, so a 20Ga EUS FNA needle is thinner than a 18Ga one. 5Fr stents are mainly used as pancreatic stents. They are placed into the pancreatic duct (PD) to allow pancreatic enzymes to flow when the risk of post ERCP pancreatitis is thought to be higher - usually when the PD has been entered a few times, or when contrast has been injected far into the PD, or as a guide for needle knife sphincterotomy. They have to be removed after a few weeks, or the end of the stent inside the pancreas can cause localised inflammation and scarring of the duct itself. We almost always therefore use one without a barb on the end so it can fall out itself. To prevent the stent migrating inside the pancreas a stent with a curved end and a straight end is used, as shown in the picture. 5cm or better still 7cm stents are used for this - so a “ 5 French 7 centimetre single pigtail pancreatic stent, please”. They are usually slid over the wire and advanced carefully into the PD using the backloaded sphincterotome as a pusher. This is so the sphincterotome and wire are ready to continue the procedure. A specific 5Fr pusher is not necessary. 3 3 3 Fr Length cm Biliary/Pancreatic - Plastic Stents Zimm Used t Order Number Reference Part Number Stent Size Fr G24566 SPSOS-3-4-N 3