Stent or bypass for jaundice: the choice

Cancer Research UK describes both routes for advanced gallbladder cancer: a stent "is a small tube that goes inside the bile duct or bowel to keep it open and stop jaundice", placed by ERCP through the mouth or by PTC through the skin between the ribs under X-ray guidance, while a bypass "means that the surgeon will cut your bile duct above the blockage and reconnect it to your small bowel". Its stent page says a plastic stent may be used if surgery to remove the cancer is planned (it is removed at the operation), whereas for advanced disease "you normally have a metal stent. This can stay in for longer and will help control the jaundice"; stents "can become blocked after a few months" and can then be unblocked or replaced the same way.

A series of meta-analyses of randomised trials (Almadi 2017) found self-expandable metal stents stay open longer and need fewer repeat procedures than plastic stents in malignant biliary obstruction, which is why metal is the default when surgery is not planned. Bypass surgery needs a general anaesthetic and a hospital stay, so it is usually chosen only when a stent fails or when the surgeon is already operating. Relieving the jaundice also matters for treatment: the site's biliary stenting record notes that bilirubin must fall before chemotherapy can be given safely. This is orientation from public patient pages, not advice for your case: your own team's instructions and 24-hour number come first.