Biliary drainage and stenting

The liver produces bile which aids digestion of fats. The bile flows through a series of small tubes (ducts) that drain into one large duct called the common bile duct, which then empties into the duodenum, the first part of the small bowel after the stomach. Bile is also stored in the gallbladder. If part of your system of bile ducts become blocked then the bile needs to be drained in another way. Percutaneous Biliary Drainage is the passage of a tube through the skin into the liver that allows bile to be drained externally. Signs of blocked bile ducts include jaundice (yellowing of the skin), dark urine, light stools, itching, nausea and poor appetite. This is a potentially serious condition that needs to be treated.

Sometimes the biliary drainage procedure my be extended with the placement of a permanent metal stent across the site of the bile duct blockage. Stents are usually inserted a few days after the first drainage procedure and they keep the narrowed duct open without the need for a catheter. Stenting may come before or after biliary dilatation, which is when a segment of bile duct is dilated with a balloon to open it up.

The most common reason to have biliary drainage is because you have blockage or narrowing (stricture) of the bile ducts. There are several conditions that may cause this, including:

• Gallstones - in the gallbladder or within the bile ducts
• Inflammation of the pancreas (pancreatitis)
• Inflammation of the bile ducts (sclerosing cholangitis)
• Tumours of the pancreas, gallbladder, bile duct, liver
• Enlarged lymph nodes in the region of the pancreas and liver due to various types of tumours
• Injury to bile ducts during surgery
• Infection

Biliary drainage relieves the blockage in the bile ducts allowing bile to leave the liver.

Biliary drainage may be necessary in preparation for surgery or other procedures on the bile ducts, such as removal of a bile duct stone or tumour.

The Consultant in charge of your case, and the Interventional Radiologist (the doctor who specialises in Imaging Procedures) who will be carrying out the Biliary Drainage, will have discussed the situation, and feel that this is the best treatment option. However, you will also have the opportunity for your opinion to be taken into account and if, after discussion with your doctors, you do not want the procedure carried out, then you can decide against it.

A specialist doctor called an Interventional Radiologist. Interventional Radiologists are experts in using X-ray equipment and in microsurgical techniques.

In the Imaging Department, in a special Interventional Radiology (IR) Procedure Room which is designed for these specialised procedures. You will be checked into the department by a nurse, who will ask some medical questions and fill out some paperwork. The Interventional Radiologist will then talk to you about the procedure, where you will have the opportunity to ask any questions or raise any concerns.

It is performed in the IR procedure room. You will lie on a special x-ray table on your back and be covered with sterile drapes.

• You will have a needle put into a vein in your arm so we can administer antibiotics, pain killers and sedation. Then your abdomen is cleaned and you will be covered in sterile drapes.
• The radiologist will inject local anaesthetic to numb the area. This may sting at first before numbing the area.
• The radiologist will use ultrasound and imaging guidance to place a plastic tube in one of your bile ducts.
• A long thin plastic tube called a drain will then be placed across the narrowed duct. One end of the tube will lie outside your body and drain into a bag. This will be secured to the skin with a dressing and is sometimes also secured with a stitch.

You may also need a stent placed into one of your bile ducts. This may happen during this first procedure or at a later date. A stent is a small metal tube that will be placed across the blockage.