Itching is a symptom of cholestatic liver disease due to biliary duct obstruction from the tumor. Till now the stent helped the bile to drain in duodenum and not to rise up the bilirubin levels in blood. The most possible cause of itching in this conditions, may be the stent stenosis due to the progressive tumor growth. So the next step is to perform a ERCP (endoscopic retrograde cholangio-pancreato-graphy) to check the stent and eventually a cholangio MRI (Magnetic Resonance Imaging). Meanwhile, appropriate management of itching sensation is very important, because it can be very distressing for the patient. Cholestyramine is still recommended as a first-line therapy for management of pruritus. I recommend that patients take cholestyramine at night so they can sleep through most of the side effects. Second/third-line therapies include rifampicin, opiate antagonists (such as naloxone or naltrexone).