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What is biliary drainage?

Biliary drainage is a procedure in which a catheter is placed through your skin and into your liver to drain your bile and is performed without surgery. A specially trained doctor, known as an interventional radiologist, performs the procedure in the radiology department. The doctor uses X-ray imaging to help precisely place the catheter.

Why do I need biliary drainage?

The most common reason for biliary drainage is blockage of the bile ducts. The liver makes bile, which aids digestion. Normally, ducts (which are like pipes) carry the bile from the liver into the bowel. When your bile ducts are blocked, the bile backs up in your liver. Signs that your bile ducts are blocked include jaundice (yellow skin color), dark urine, light stools, nausea and poor appetite. Some people experience severe itching.
Biliary drainage can relieve these symptoms by giving the bile a pathway to leave the liver.Biliary drainage may also be needed if a hole forms and bile leaks from the duct. This leakage can cause pain and severe infection. Biliary drainage can stop the leaking and help the hole to heal over.
Biliary drainage may also be needed in preparation for surgery or for some other procedure on your bile ducts, such as removal of a bile duct stone.

How do I prepare for my biliary drainage?

If you are already a patient in the hospital – your nurses and doctors will give you instructions on how to prepare for your biliary drainage.
If you are being admitted to the hospital on the morning of your biliary drainage 0R if you are having your procedure done as an outpatient – follow these instructions unless your doctor specifies otherwise:
Eating. Do not eat any solid food after midnight on the night before your procedure. You may drink clear fluids.
Medication. Most people can continue taking their prescribed medicines. If you are a diabetic and take insulin, ask your doctor about modifying your insulin dose for the day of your procedure. If you take the blood thinner Coumadin, you must tell your doctor so that it can be stopped. Bring all your medications with you.
You will need to have blood work before your biliary drainage. On the day of the procedure, an intravenous (IV) line will be placed in one of your veins and antibiotics will be given. The antibiotics help to prevent infection. The IV will be used to give you other medicines and fluids during the procedure.
Before our biliary drainage begins, a member of the interventional radiology team (doctor, nurse, or technologist) will discuss the procedure with you in detail and answer any questions you might have. The team member will also ask you some general questions about your health and any possible allergies.

What is a biliary drainage procedure like? Does it hurt?

Before the procedure starts, pain medication will be given to you through your IV. Additionally, your interventional radiologist will use local anesthetic to numb the skin and deeper tissues in the area where the catheter will be placed. After that, you will still feel some pressure during the procedure.
Biliary drainage has three major steps: placement of a needle into a bile duct, placement of a guide wire farther into the duct, and placement of the drainage catheter over the wire. The entire procedure usually lasts about two hours, but it may take longer. It is not possible to know in advance exactly how much time your biliary drainage will require.

How do I keep my biliary catheter from becoming blocked, so that I won’t get a bile duct infection?

Sometimes, despite your best efforts, your biliary catheter can become blocked. The following instructions can reduce the risk:

What happens after my biliary drainage?

After the procedure is over, you will go from the radiology department to your hospital room. Your nursing staff will observe you. They will let you know when you can eat and how long you need to stay in bed. Because everyone is different, it is not possible to predict how many days you will need to stay in the hospital.
If you had symptoms of bile duct blockage (such as jaundice) before your biliary drainage catheter was placed, you will notice those symptoms gradually disappear. You will be sore for seven to 10 days after your catheter is inserted.
The biliary drainage catheter is small, about the same size as IV tubing. At first, it will be connected to a drainage bag and your bile will drain into the bag. In many cases, the drainage bag will not be needed after a few days and the catheter will be capped off.

How long will I need the drainage catheter?

How long you will need your catheter depends on why you need your catheter. If the catheter is to be placed to relieve blockage of the bile ducts, you will need the catheter as long as the blockage is present. Your bile ducts can be blocked by stones, infection, scar tissue or tumor. Some patients need their biliary drainage catheter for the rest of their lives. If your catheter is to be placed because you have a hole in your bile duct, you will need the catheter until the hole has healed. If your catheter is to be placed in preparation for bile duct surgery, you will need it until after your surgery. Your doctors will discuss with you how long you are likely to need a biliary drainage catheter.

What are the risks of biliary drainage?

Biliary drainage is safer than surgery, but complications can occur. The two most frequent complications are bleeding and infection. That is why you need to stay in the hospital after the catheter is placed. Because everyone is different, there may be risks associated with your biliary drainage that are not mentioned here. A member of your interventional radiology team will discuss the risks of your biliary drainage procedure with you in detail before the procedure starts.

What are the benefits of biliary drainage?

If your bile ducts are blocked, the biliary drainage catheter will relieve your symptoms, such as jaundice and itching. Before this drainage procedure was developed, patients with blocked bile ducts had to undergo surgery to drain the bile.
In some cases, the catheter can help your doctors eliminate the source of the blockage. For example, if your bile ducts are blocked with stones, your interventional radiologist may be able to remove the stones through the catheter tract without surgery. If your bile ducts are blocked with scar tissue, your interventional radiologist may be able to use instruments through the catheter tract to enlarge the duct in the area of scarring. In some cases, a permanent stent can be placed in the duct to hold it open. Your doctors will talk to you about the best way to manage the cause of your blocked bile ducts.