Biliary Drainage

What Is A Biliary Drainage?
It is a procedure in which a catheter is placed through your skin and into your liver to drain bile, and is performed without surgery. An interventional radiologist, a specially trained doctor, performs this procedure in the Radiology Department. The doctor uses x-ray imaging (like a TV screen) to help place the catheter in the proper location.

Why do I need a biliary drain?
Blockage of the bile ducts is the most common reason for the biliary drain. Your liver makes bile, which aids in digestion. The ducts (which are like pipes) normally carry bile form the liver to the bowel. If your ducts are blocked, the bile backs up into your liver. Some of the signs which may occur are jaundice (yellow skin color), dark urine, light stools, nausea, and poor appetite. Some people even experience severe itching. These symptoms can be relieved with a biliary drainage which gives the bile a pathway to exit the liver.

A biliary drain may also be needed if a hole forms and bile leaks out of the duct, which can cause pain and severe infection. A biliary drain can stop the leaking and help the hole to heal over.

What do I do to prepare for my biliary drainage?
Inpatients: Your nurses and/or doctors will give you instructions on how to prepare.

Outpatients or those being admitted the morning of exam: You should follow these instructions unless your doctor tells you otherwise.

1. Do not eat any solid foods after midnight on the night before your procedure. You may drink clear fluids and take your normally prescribed medications.
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 appropriately. Bring all your medications with you.
2. You will need to have blood work before your biliary drainage. As an outpatient, your blood work will be drawn two hours before your procedure. On the day of your procedure, an intravenous (IV) line will be place din one of your veins and antibiotics will be given. The antibiotics help in the prevention of an infection. The IV will also be used to give you other medicines and fluids during the procedure.
3. Before your biliary drainage, a member of the interventional radiology team (doctor, nurse or technologist) will discuss the procedure with you in detail and answer your questions. You will also be asked about your general health and if you have any allergies.

What is the procedure like and will it hurt?
Before the procedure begins, pain medication will be given to you through your IV. The radiologist will also use a local anesthetic to numb the skin and deeper tissues where the catheter will be placed.

There are three major steps to a biliary drainage:

1. Placement of a needle into the bile duct.
2. Placement of a wire farther into the duct through the needle.
3. Placement of a drainage catheter over the wire and into the bile duct.

The procedure takes about two hours, but it may take longer.

What happens after my biliary drainage catheter has been inserted?
Inpatient: You will return to your room and your nursing staff will observe you. They will let you know when you may eat and drink and how long you should stay in bed.

Outpatient: You will be taken to an observation area for 6-23 hours to be monitored before being released. The staff there will let you know when you can eat or drink and how long you need to stay in bed. If you had symptoms (such as jaundice) you will notice these symptoms gradually disappear. You will be sore for 7-10 days after your catheter is inserted.

The drainage catheter is small, about the same size as IV tubing. Your catheter will be connected to a drainage bag and your bile will drain into it. In some cases it may not always be necessary to drain into a bag and your catheter may be capped or shut off. This depends on the location of the catheter in your duct.

How long will I have to have the drainage catheter?
How long will you need your catheter depends on why your catheter was placed. If it was placed because your bile ducts were blocked, you will need it as long as they are blocked. They can be blocked by stones, infection, scar tissue, or a tumor. Some people need their biliary drain for the rest of their lives. If your catheter was placed because of a hole in your duct, you will need it until the hole has healed. Your doctors will discuss with you how long you will need your biliary drainage catheter.

Are there risks to a biliary drainage?
The two most frequent complications are bleeding and infection. That is why you need to stay in the hospital and be observed for a period of time.

What are the benefits of a biliary drainage?
Before this drainage procedure was developed, patients with blocked bile ducts had to undergo surgery to drain the bile. Now, many patients can avoid surgery.

In some cases, the catheter can help your doctors eliminate the source of the blockage. If your bile ducts are blocked with stones, your interventional radiologist may be able to remove the stones through the tract the biliary drainage catheter has made without surgery. If your bile ducts are blocked by scar tissue, your interventional radiologist may be able to use instruments through the catheter tract to enlarge the duct in the area where the scar is. In some cases, a permanent stent can be placed in the duct to hold it open. Your doctors will take to you about the best way to treat the cause of your blockage.