Biliary Drainage and Stenting

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Percutaneous transhepatic biliary drainage (PTCD) is the placement of a drain into bile ducts using needles inserted through the skin. Biliary stenting is performed after biliary drainage if the blockage is … Read More

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Biliary Drainage and Stenting

Percutaneous transhepatic biliary drainage (PTCD) is the placement of a drain into bile ducts using needles inserted through the skin. Biliary stenting is performed after biliary drainage if the blockage is malignant (cancerous) to keep the bile duct open and to allow the drain used in PTCD to be removed.

What Is A Biliary Drainage?

For the human body to function normally, the digestive system must break down the food you eat and absorb the necessary nutrients directly into your bloodstream. Many organs participate in this process, such as the liver producing bile juice, which helps break down the fats that enter your small intestines. The bile juice produced by the liver passes through the bile ducts and into the small intestine. However, similar to arteries and blood vessels, these bile ducts can sometimes develop blockages due to cancer. When jams appear, these bile salts slowly start building up in your liver and blood. This often results in severe pain, high fever, and jaundice symptoms such as yellow eyes, dark yellow-colored urine, and pale stools. Also, fluids may start to accumulate in your upper as well as your lower abdomen causing the subject to feel bloated and restless at all times. If not treated on time, this situation can lead to severe infections, often resulting in liver failure.  The blockages have to be treated correctly and just in time. If the subject fails to do so, this condition eventually leads to life-threatening infection and can even result in liver failure. But biliary drainage is a procedure used to remove the built-up bile juices and other bodily attractions by using a biliary drainage tube.

Biliary Drainage Procedure

The Biliary Drainage Procedure is carried out by a doctor and an interventional radiologist using a local anesthetic. With either an X-Ray or ultrasound, the radiologist inserts a tube through the liver directly into the bile duct. A guidewire placed through the tube allows direct and position the drainage stent into the desired location and position. Once the procedure is complete, the tube allows the bile juice to drain away externally into a bile bag.  However, if good internal drainage can be achieved through your small intestine, there is no need for a bile bag. To make the tube comfortable and appear discreet, doctors often apply a low-profile device to the outer end (body). If the biliary drainage tube is inserted successfully and the blockages/obstructions are removed/relieved, the liver’s functioning automatically improves, resulting in the patient feeling much better.

Why Do Bile Duct Blockages Occur?

The liver secretes bile juice, which is stored in the gallbladder during meals. When you eat, the gallbladder pushes this juice into small tubes called the bile ducts. As the name suggests, Bile duct blockages are the obstructions that appear in any of the bile ducts that carry bile secreted by the liver and stored in the gallbladder to the intestine. The bile duct starts as small ductules within the liver, which carry the liver cells’ secretions. These bile ducts combine to form two major and one minor duct, which then drains the bile juice through the bile ducts into the small intestine to break down fats. A blockage of this duct prevents the bile from flowing from the liver to reach the small intestine.

What Is The Biliary Stent?

The biliary stent is a thin hollow flexible tube that has multiple small holes along the edges. This tube/stent’s primary function is to ensure that the bile from the liver flows into the intestines when the bile duct is blocked. Depending upon the type of biliary stent inserted inside your body, it may either be connected to a bile/drainage bag outside of your body.

Biliary Drainage Stent Guidelines

It is imperative that you take care of your biliary stent after placement to keep functioning and prevent further infections. Always keep the dressing/bandaged portion over the tube clean and dry. There will be a stitch holding the stent in place. However, if the stitch is ruptured, tape the stent to your skin using doctored tape and call your concerned Radiologist at once. The Biliary Drainage Stent has a lock keeping it in place from the inside. Do NOT open the lock. Change the dressing/bandage every day without fail. Similarly, it should be changed at once if it becomes wet or soiled or unless advised otherwise. Seek help if you wish to change the dressing as it will be easier than you doing it. Always keep the drainage bag below the stent site to drain properly and ensure that the biliary stent remains in a proper position, doesn’t become twisted, and the holes along the stent do not get blocked. Use a safety pin/elastic band, yoyo,  to attach the drainage to your clothing. NEVER let your drainage bag hang off your body as it may create tension along with the stitches, causing the accidental removal of the biliary stent. 

Post Surgical Guidelines

The patient is forbidden from driving any vehicle ffpost the surgery because of the medications he/she receives during the procedure. Similarly, the patient is advised to eat minimally on the day of the surgery but can return to his/her original diet the next day. Your body loses lots of fluids to the drainage bag. Therefore, the subject is advised to drink lots of electrolytes to make up for the lost fluids (example: Gatorade, coconut water, milk, Pedialyte).  The patient is advised to drink at least ten water glasses each day when the tube is in place. Your doctor will recommend what you should drink to replace the fluids lost by the drainage bag.  Do NOT sleep or lie on the same side so as to keep the drainage tube from twisting. The patient can resume his/her everyday activities 24 hours post the procedure. However, Patients are not allowed to lift anything heavier than 8 pounds unless advised against. All the prescribed medications should be taken as and when they are scheduled unless advised against doing so. Patients can take a lukewarm shower two days after the procedure. No swimming or soaking in water is permitted as long as the tube is in place.

Flushing Your Biliary Drain

Every time before you apply the new dressing, the biliary drainage tube needs to be flushed. Since bile is a thick fluid, you will need to flush the tube to ensure proper drainage gently. The holes along the tube should NEVER become blocked. Your doctors and caregivers will advise you on how often you should flush your biliary drainage tube.  To flush your biliary drain, you need a prefilled 10mm sodium chloride-filled syringe and some alcohol pads. If your tube is capped and unattached to the drainage bag, use the alcohol pad to wipe the end of your tube. Slowly take the white cap off the syringe and twist this syringe onto the end of the cap. Slowly push the contents of the syringe into the biliary drain. Always remember, the fluid enters quickly when you apply gentle pressure.

Symptoms

• Jaundice. Normally, bile is made by the liver and released into the intestine.
• Itching. Excess bilirubin in the skin can also cause itching.
• Light-colored/greasy stools
• Dark urine.
• Abdominal (belly) pain.
• Loss of appetite/weight loss.
• Fever.
• Nausea and vomiting

Causes

• Primary sclerosing cholangitis. This disease causes hardening and scarring of the bile ducts.
• Chronic liver disease.
• Bile duct problems present at birth.
• A liver parasite.
• Older age.
• Smoking.

FAQ

Are Further Treatments Required?

Post the procedure, your oncologist will schedule a follow-up to inform you whether your condition has improved enough to proceed with further treatments such as chemotherapy, radiation, and surgery.

What is Biliary Drainage & Stenting Cost?

The average cost of Biliary Drainage And Stenting Cost in India starts from USD 2000. 

When Should You Call The Doctor?

Here are some of the signs and symptoms post which you should immediately call the doctor:

  • Redness,
  • Swelling,
  • Foul Odor,
  • Drainage,
  • Abdominal Pain
  • Nausea
  • Vomiting
  • Light Colored Stools
  • Shaking Chills 
  • High Fever
  • Yellowing of the Skin/Eyes
  • Dark Urine

If any of the above signs and symptoms develop around the skin, you must consult your doctor. If your stent is capped, uncap it and attach it to the drainage bag. Always ensure that the biliary drainage bag is below the level of the tube site. However, if the stent tube is already attached to the drainage bag, gently remove the dressing and check to see whether the stent is twisted and straighten the tube if it is twisted. Even if the fluid doesn't start flowing once you straighten it, you will need to flush the tube gently. But if all these steps fail to relieve you of the symptoms you're having, call your doctor or visit your nearest hospital/emergency room at once. 

When should you make a follow-Up visit?

The biliary drainage tube has to be changed from time to time to reduce the risk of any infection and ensure it drains properly. If you do not have a follow-up visit scheduled, call the doctor or the hospital to arrange for one.