The first step in applying a stent to the biliary tree is to define the location of the stricture to be stented. This is achieved through ERCP and passage of a fine guidewire. Allowing for slight magnification of the radiographs, a suitable stent size is chosen. Bile and contrast media are then aspirated from the biliary tree.
The guiding channel of the endoscope then forms the route for the passage of the stent. Initially, a 0.035 inch guidewire is passed through this channel and thence through the stricture. A 6.5 F grade guiding-catheter is passed over this. Finally, the stent is pushed over the guiding catheter to the stricture by a 10F pushing-tube. Careful removal of guidewire and tubes leaves stent in place.
Some operators use either dilatation via catheter or sphincterotomy prior to stent insertion.
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