Biliary Drainage and Stenting

What will happen?

After hospital admission, you will arrive into the Interventional Radiology Suite where the interventional radiologist (a doctor specially trained to perform this procedure) and radiographer will explain the procedure and answer your questions. The study usually takes about 60-80 minutes. After completion, you will be transferred to your ward when you will be monitored. If no complication occurs, you may go home the following day. However, the discharge from the hospital will depend on your general health status and this will be decided by your attending physician or surgeon.

Do I need any test before the procedure?

You will be asked to have following blood tests:

PI/FIT/Platelets — to assess the risk of post procedural bleeding.

You should discuss any allergy history (particularly to Iodine) with the radiologist prior to booking biliary drainage.

Biliary drainage procedure

You will have a drip placed in the arm for vascular access. Mild sedation might be required. You will be lying on your back and under local anesthesia and sterile conditions, a small incision will be made on your skin. The radiologist will use X-rays and ultrasound to insert a thin needle into your liver. Contrast (x-ray dye) will be injected and drainage catheter will be inserted into your liver.

The catheter will be connected to a drainage bag and the insertion site will be covered with a dressing. The bile in the bag may contain some blood at first; however the blood usually clears with time.

You and/or the member of your family will be instructed about the bag care.

Biliary stenting procedure

The best time for the stent insertion is 48 hours after biliary drainage when the bile ducts in the liver are well decompressed. Under sterile conditions and local anesthesia the drain will be gently removed and over the guide wire, the metallic stent will be inserted at the site of narrowing to allow natural passage of the bile into the intestines. The drain will be reinserted, but will remain closed for the next 24-48 hours after which you will have the final injection of contrast. It will confirm that the stent is patent and the external drain will be removed.

What will I feel? Does it hurt?

You will feel a bee sting when the doctor numbs the skin. You may feel some pressure and discomfort when the tube or stent are inserted. We may need to give you extra medication to help you relax and to reduce your pain.

Some discomfort is to be expected for the first week after the tube insertion. Patients are usually unaware of the stent presence.

What are the risks?

Bleeding at the puncture site happens seldom and is usually minimal. In the unlikely case of arterial bleeding, surgical intervention or embolization may be necessary to control it.

Infection can be expected with prolonged procedure. We may need to give you antibiotics to prevent it.

Allergic reaction to X ray contrast is very rare (moderate to serious reactions occur in 1/50.000 — 150.000 people). You should mention any allergy history to the radiologist in order to organize appropriate anti-allergic regime.

Migration of the metallic stent is almost unknown; its position is carefully checked by the contrast injection

When will I get my results?

The radiologist will be able to talk to you and the members of your family after the intervention and advise if the procedure was technically successful.

When will I resume my normal activities?

If no complications occur, you will be able to get back to your normal life the next day – particularly if the stent is inserted and you are discharged without the tube. You will have to avoid any heavy physical activity while the tube is inserted and to take showers instead of a bath

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