What is the first step in placing an endobiliary stent?

The first step in placing an endobiliary stent is to confirm the presence of common bile duct (CBD) stones through cholangiography. This step is crucial because it allows the surgeon to visualize the anatomy of the bile ducts and the presence of any obstructions, such as stones. By performing cholangiography, the clinician can identify the exact location, size, and number of stones, ensuring that the intervention is appropriate and safe.

Once the presence of stones is confirmed, the appropriate steps can be taken to manage them, whether that involves addressing the stones before placing the stent or proceeding with stenting to facilitate bile drainage if a blockage is confirmed. Therefore, the cholangiography step is foundational and sets the stage for any subsequent procedures, including stent placement.

In other procedures, steps such as removing the gallbladder, injecting contrast into the cystic duct, or advancing the stent through the ampulla may follow but are dependent on the initial confirmation of stones and biliary pathology through cholangiography.