A 45-year-old male patient, with known history gastric carcinoma and previous treatments including gastrectomy with gastrojejunostomy, and partially discontinued chemotherapy, recently faced obstructive jaundice due to lymph nodal metastases. Following an MRCP, a minimally invasive PTBD and SEM biliary stenting were performed under IV anesthesia:

– Cholangiogram identified a tight stricture in the hepatic duct, CBD, and duodenum.
– Successful negotiation of the strictures with a guidewire and catheter.
– Serial dilatation was conducted, opting out of balloon dilatation due to hypervascularity.
– Placement of a 10mm x 80mm SEM biliary stent with external drainage at the confluence.
– Post-stenting cholangiogram displayed smooth contrast flow into the duodenum.

The post-procedure recovery was smooth, with notable improvements in bilirubin levels and confirmed stent expansion during follow-up. This case highlights the pivotal role of Interventional Radiology in addressing intricate oncologic biliary obstructions, providing palliative care and enhancing the quality of life for patients with advanced malignancies.