Biliary interventions

Biliary interventions are minimally invasive procedures used to treat blockages or narrowings in the bile ducts. These techniques can also be used to treat inflamed or infected gallbladders. When the flow of bile to the intestine is blocked, it can lead to jaundice, a condition characterized by yellowing of the skin and eyes due to the buildup of bilirubin in the blood.

If the duct connecting the gallbladder to the common bile duct is blocked (often caused by gallstones), inflammation or infection can occur, a condition known as cholecystitis. Typically, the treatment for this condition is surgical removal of the gallbladder, either through laparoscopy or open surgery. However, for patients who are too ill to undergo surgery, percutaneous cholecystostomy, a minimally invasive procedure performed by an interventional radiologist, can be performed to drain the gallbladder.

Types of Biliary Interventions

Interventional radiologists perform a variety of minimally invasive procedures to treat conditions affecting the biliary system. These procedures include:

• Percutaneous Transhepatic Cholangiography (PTC): A diagnostic procedure that involves inserting a needle through the skin and liver to inject contrast material into the bile ducts. This allows the radiologist to visualize the bile ducts and identify any blockages or abnormalities.
• Stenting: A small, tubular device is placed inside a narrowed or blocked bile duct to keep it open and allow bile to flow freely.
• Percutaneous cholecystostomy: In this procedure, a needle and tube are inserted through the skin and into the gallbladder to drain bile and relieve pressure. This is often performed in patients who are too ill to undergo surgery to remove the gallbladder.

What should you tell your doctor before the procedure?

• Any allergies, especially to local anesthetics, general anesthesia, and contrast media.
• A complete list of medications you are taking, including over-the-counter drugs, herbal supplements, and blood thinners.
• Any history of bleeding disorders or other medical conditions.
• If you are pregnant.

How to prepare for a biliary intervention?

These procedures may be performed on an outpatient basis or may require hospitalization. Your doctor will determine the necessary preparation. Before the procedure, you may need blood tests to check your kidney function and clotting ability. Imaging tests such as ultrasound, CT scan, or MRI may also be performed. You may be asked to fast for a certain period before the procedure. You will be asked to change into a hospital gown and remove any jewelry or metal objects. Arrange for a friend or family member to drive you home after the procedure.

Biliary interventions Procedure

Before the procedure, you may be given medications to prevent nausea, pain, and infection. A nurse or technologist will start an IV line to administer sedatives.

Advantages of Biliary Interventions

• Minimally invasive: Procedures require only a small skin puncture, avoiding the need for large incisions.
• Reduced complications: Patients experience fewer complications compared to open surgery.
• Shorter hospital stay: Recovery time is significantly shorter.
• Faster recovery: Patients can often return to their normal activities more quickly.

Potential Complications of Biliary Interventions

• Infection: There is a small risk of infection at the puncture site.
• Allergic reactions: Patients may have an allergic reaction to the contrast material used during the procedure.
• Bleeding: Minor bleeding may occur at the puncture site.  
• Organ damage: In rare cases, organs such as the intestine may be punctured.
• Restenosis: The blockage may recur, especially with stents.

Limitations of Biliary Interventions

• Not suitable for all patients: Certain medical conditions or the severity of the blockage may make minimally invasive procedures unsuitable.
• Potential for recurrence: Blockages or complications may recur, requiring additional procedures.