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Patient Profile
Patient Name
Mr. Suresh Iyer
Consultant
Dr. Vipulroy Rathod
Diagnosis
Obstructive Jaundice from an Inoperable Malignant Bile Duct Stricture
Age / Gender
67 Years / Male
Hospital
Fortis Hospitals Limited, Mulund, Mumbai
Past History
Progressive yellowing of eyes and skin over three weeks, unexplained weight loss, controlled type 2 diabetes
Patient Background
Mr. Suresh Iyer, a 67-year-old retired schoolteacher from Nagpur, Maharashtra, first noticed his eyes turning yellow along with dark coloured urine and unusually pale stools. Over the following two weeks he also developed persistent itching all over his body and lost several kilograms without any change in diet. Local investigations pointed to a blockage in the bile duct, and further imaging suggested a tumour at the head of the pancreas encasing nearby blood vessels, making surgical removal unsafe. With curative surgery ruled out, his family sought a specialist experienced in advanced biliary procedures. Dr. Vipulroy Rathod, Consultant Gastroenterologist at Fortis Hospitals Limited, Mulund, Mumbai and an expert in therapeutic ERCP, recommended endoscopic biliary stenting to relieve the blockage and clear the jaundice without any surgical incision.
Symptoms
Progressive yellowing of the skin and eyes over about three weeks
Dark coloured urine and pale, clay-coloured stools
Persistent, generalised itching that disturbed sleep
Unexplained weight loss of about six kilograms over six weeks
Loss of appetite and a dull, ongoing discomfort in the upper abdomen
Diagnostic Method
Liver function tests
showed markedly raised bilirubin and an obstructive pattern of liver enzymes, confirming a blockage in the flow of bile
Abdominal ultrasound
revealed dilated bile ducts within the liver, pointing to a blockage lower down near the head of the pancreas
Contrast enhanced CT and MRCP
identified a mass at the head of the pancreas causing a tight stricture of the bile duct, with involvement of adjoining blood vessels that made the tumour unsuitable for surgical removal
Endoscopic ultrasound with biopsy
obtained tissue confirmation of a malignant stricture and helped stage the extent of local spread
Pre-procedure evaluation
included correction of vitamin K dependent clotting factors, blood investigations, and fitness assessment for therapeutic ERCP
Disease Diagnosed
Mr. Iyer was diagnosed with obstructive jaundice caused by a locally advanced, inoperable cancer at the head of the pancreas compressing the bile duct. Because the tumour had grown around nearby blood vessels, curative surgical resection was not possible. Left untreated, the blocked bile duct would continue to raise bilirubin to dangerous levels and place him at risk of infection within the bile ducts. As a specialist in advanced endoscopic biliary procedures, Dr. Rathod identified endoscopic biliary stenting as the most appropriate way to relieve the obstruction, control the jaundice, and improve his quality of life while further oncological treatment was planned.
Risks if Left Untreated
Progressive rise in bilirubin leading to worsening jaundice and liver dysfunction
Cholangitis, a serious infection of the bile ducts, due to stagnant bile
Persistent, distressing itching and poor appetite affecting nutrition
Delay in starting chemotherapy, since liver function must be controlled first
Treatment Plan
Dr. Dr. Vipulroy Rathod performed Endoscopic Retrograde Cholangiopancreatography (ERCP) with biliary stenting, a procedure that clears the blocked bile duct and restores the flow of bile from inside the digestive tract, without any cut on the abdomen.
Why Endoscopic Stenting Was Chosen Over Surgery
01 — No Abdominal Incision
The stent is placed entirely through the endoscope, passed through the mouth down to the bile duct opening. No abdominal cuts, no external scars, and no surgical wound.
02 — Suitable for Inoperable Disease
When the tumour cannot be safely removed by surgery, stenting offers effective relief of jaundice without requiring the patient to undergo a major operation.
03 — Metal Stent for Durable Drainage
A self-expanding metal stent was chosen over a plastic stent for longer lasting patency, reducing the chance of the stent blocking again in the near term.
04 — Faster Recovery
A day or two of observation instead of a prolonged surgical recovery. Most patients see bilirubin begin to fall within days, allowing earlier planning of oncological treatment.
How the Procedure Was Performed
- Endoscope passage: a side viewing endoscope was passed through the mouth into the duodenum to reach the opening of the bile duct
- Cannulation and cholangiogram: the bile duct was selectively entered with a guidewire, and contrast dye was injected to map the exact site and length of the blockage
- Stricture crossing: the guidewire was carefully advanced across the narrowed segment to secure access beyond the blockage
- Stent deployment: a self-expanding metal stent was positioned across the stricture and released, restoring an open channel for bile to drain
- Drainage confirmation: free flow of bile past the stent was confirmed before the endoscope was withdrawn
Procedure Summary
| Procedure | Endoscopic Retrograde Cholangiopancreatography (ERCP) with biliary metal stent placement |
| Approach | Entirely transoral through the endoscope, no external incision |
| Duration | 45 minutes |
| Sedation | Conscious sedation with continuous monitoring |
| Hospital Stay | One night for observation of bilirubin trend and general recovery |
Doctor’s Quote
“When a tumour blocking the bile duct cannot be removed surgically, our priority shifts to relieving the jaundice as safely and quickly as possible. Working entirely through the endoscope, we opened the blocked duct and placed a metal stent to restore normal bile flow, with no incision at all. Mr. Iyer’s jaundice and itching began settling within days, and he was soon fit enough to begin further cancer treatment. For inoperable blockages like this, endoscopic stenting makes a real difference to comfort and quality of life.”
Dr. Vipulroy Rathod, Consultant Gastroenterologist, Fortis Hospitals Limited, Mulund, Mumbai
Post-Procedure Guidelines
Clear liquids on the evening of the procedure, advancing to a light and then normal diet the next day
Regular blood tests to track the fall in bilirubin and liver enzymes over the following weeks
Watch for and promptly report fever, chills, worsening abdominal pain, or recurrence of jaundice
Early consultation with the oncology team once liver function normalises, to plan further cancer directed treatment
Follow up with Dr. Rathod for stent function review and timely management if the stent requires exchange
Outcome
| Day 1 | Bile drainage confirmed during the procedure, no immediate bleeding or pain, tolerating oral fluids |
| Day 2 | Discharged with bilirubin already trending down, itching noticeably reduced |
| 1 Week | Jaundice visibly improving, appetite returning, stools normal in colour |
| 1 Month | Bilirubin and liver enzymes back within a near normal range, oncology treatment underway |
| 3 Months | Stent functioning well on imaging, jaundice fully resolved, weight stabilising |
Long-Term Expectations
With the bile duct blockage relieved, Mr. Iyer’s jaundice has resolved, and his liver function has stabilised, allowing him to proceed with ongoing cancer directed treatment. Since the underlying tumour remains, periodic imaging and liver function monitoring will continue, along with review of stent function, as metal stents can occasionally narrow again over time and may need further endoscopic management. Close coordination between gastroenterology and oncology will remain central to his continuing care.
Patient Feedback
“Being told that surgery was not possible was frightening, and the yellowing and itching had made daily life very difficult. Dr. Rathod explained that a stent placed through the scope could open the blockage without any operation. Within days the yellowness in my eyes started fading and the itching eased. I am now able to eat properly and continue my cancer treatment with much more strength.”
Suresh Iyer, 67 | Nagpur, Maharashtra
“We were devastated to hear surgery was not an option. Dr. Rathod and his team explained the stenting procedure patiently and reassured us at every step. Seeing my father’s jaundice clear up within a week gave our family real hope, and he has since been able to continue with his further treatment comfortably.”
Mr. Karthik Iyer, Patient’s Son | Nagpur, Maharashtra
