Many people are not candidates for surgery by the time bile duct cancer is diagnosed. However, minimally invasive, image-guided procedures can help improve their quality of life by allowing bile to flow through or drain out of a bile duct that is blocked by a tumor. Our surgeons and experts in interventional radiology use tools, such as catheters and needles, to relieve such symptoms as jaundice (yellowing of the skin and the whites of the eyes), itching, nausea, vomiting, and infection.
A biliary bypass connects the bile duct or gallbladder directly to the small intestine. This creates a new way for bile to get around a tumor that is blocking the flow from the bile duct. Our doctors can often perform a biliary bypass using a laparoscope (a thin lighted tube with a camera on its tip) inserted through a small incision (cut) in the belly.
A stent is a small tube that can relieve a blocked bile duct so bile can flow across a blockage to the small intestine. When possible, the stent is placed using an endoscope (a small tubelike instrument) inserted through the mouth. When that method is not possible, a stent can be placed with a needle inserted through the liver. Imaging is used to identify the blockage and place a stent (or a drainage catheter, a small flexible tube) through the blockage. Some people may need to have a catheter for a while after getting a stent.
Neurolytic Celiac Plexus Block
People with advanced bile duct cancer often have pain. The pain may be caused by cancer cells that have invaded a cluster of nerves near the liver known as the celiac plexus. People who don’t get enough pain relief with conventional drugs may benefit from a procedure called neurolytic celiac plexus block (NCPB). This involves injecting a local anesthetic into the celiac plexus to disrupt the body’s pain signals. MSK doctors were among the first to use this technique. NCPB has been shown to reduce pain significantly and improve mood and life expectancy for people with advanced bile duct cancer.
Doctors at MSK have shown that NCPB can be performed with a laparoscope while examining the bile duct to diagnose and stage the cancer. Many other cancer centers perform percutaneous NCPB (through the skin) with a needle. This method is associated with side effects, such as muscle and limb weakness. Laparoscopic NCPB may provide similar or better pain relief than percutaneous NCPB with fewer potential side effects.
NCPB also can be performed using an endoscopic ultrasound. This involves inserting a small probe through the mouth and into the stomach to get a detailed view of the celiac plexus. As with laparoscopic NCPB, endoscopic NCPB may be at least as effective as the percutaneous approach, with fewer potential side effects.
Ablation destroys cancer cells by delivering heat or cold through a needle placed into a bile duct tumor. It requires no incisions (cuts) and is effective for some people with isolated tumors who are not candidates for bile duct surgery.
In this technique, microscopic beads are injected into blood vessels that feed the bile duct tumor to cut off its blood supply. This can kill the tumor.