Special Procedures - Biliary Drainage

Biliary drainage and stent placement procedures allow for drainage of an obstructed biliary system through a catheter placed through the skin into a bile duct within liver. These procedures are frequently performed on patients with symptomatic obstructive jaundice most often the result of a malignant process (such as pancreatic, biliary or liver cancer) or a benign process (such as gallstones, common bile duct stones or benign strictures).  Most of these procedures are performed under general anesthesia.

Patients with obstructive jaundice as the result of stones are commonly treated by a gastroenterologist (GI doctor) with ERCP (endoscopic retrograde cholangiopancreaticduodenography), but may become candidates for biliary drainage if endoscopic procedures are unsuccessful or not possible for anatomic or clinical reasons.

Biliary drainage procedures involve the use of ultrasound and fluoroscopic imaging to map patient anatomy. A local anesthetic is injected (in the patient's right side usually). A hollow needle is inserted through a small incision in the skin, into a bile duct (within the liver). A small amount of contrast (dye) is injected into the catheter to verify its proper placement.

A series of dilators, guidewires and catheters (tubes) are advanced toward and through the area of obstruction to establish an internal or external drainage path. The path may provide permanent or temporary drainage of bile fluids into the first portion of the small intestine (duodenum) or externally into a bag.

In some circumstances of malignant disease, an internal metal stent may be placed during a follow up procedure at the area of obstruction as a form of permanent treatment. In the circumstance of a benign process, the drain tube may be left in place to drain internally or externally into a bag for several months.