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Biliary Interventions

The liver is an organ in the right upper quadrant of the abdomen that serves many important functions. One of such functions is the creation and excretion of a substance called bile, which removes waste products and aids in digestion. The gallbladder is a related organ that sits next to the liver and collects the bile so that it can be delivered to the gut after eating.

Many different diseases can affect the ducts connecting the liver, gallbladder, and gut. From helping to interpret diagnostic exams such as CT, MRCP, and cholangiography to treating biliary blockages with balloons, tubes, and stents, the Interventional Radiologists at Houston Radiology can help the liver and surgeons at every stage of biliary/gallbladder disease.

Cholecystostomy placement

If the duct draining the gallbladder gets blocked, the fluid in gallbladder can build up and become infected, which is known as “acute cholecystitis”. Acute cholecystitis can be treated by surgically removing the gallbladder. If, however, the patient is too ill, surgery may be too dangerous. In these cases, the Interventional Radiologists at HRA can use imaging guidance to place a drain into the gallbladder. This drain lets us remove the infected fluid helps the patient recover.

The procedure has a mild risk of bleeding, infection, and damage to nearby organs. If possible, patients should refrain from eating and drinking for 6 hours prior to the procedure and will be given medications to help them relax (i.e. moderate sedation). The procedure is typically reserved for inpatients, who will then remain in the hospital overnight after their procedure.

Percutaneous biliary drainage catheter placement

The common bile duct is a large connection between the liver, the gallbladder, and the gut. It can be blocked by many diseases, but it is most commonly blocked by either a gallstone or tumor. This blockage prevents the liver and gallbladder from removing the bile, which will eventually cause the liver to stop working well and cause pain, yellowing of the skin, poor digestion, and infection.

Blockages can be treated by gastroenterologists with an endoscope, surgeons with a bypass, and/or interventional radiologists with a drain. Interventional Radiologists treat the blockage by using a mixture of ultrasound and x-rays to advance a needle across the liver into a bile duct. Contrast is injected to look at the ducts and evaluate the location of the blockage. Then a wire is advanced through the needle into the bile duct. The needle is exchanged for a catheter, and the wire is removed. This catheter is left is in place to help the bile drain around the blockage.

The procedure has a moderate risk of bleeding, infection, and damage to nearby organs. If possible, patients should refrain from eating and drinking for 6 hours prior to the procedure and will be given medications to help them relax (i.e. moderate sedation). The procedure is typically reserved for inpatients, who will then remain in the hospital overnight after their procedure.

Percutaneous biliary endoscopy

After a biliary drain has been placed, a small tube with a camera (endoscope) and tools can be advanced across the skin into the biliary system/gallbladder in order to look at the blockage, obtain a sample, or even break apart/remove a stone.

The procedure has a moderate risk of bleeding, infection, and damage to nearby organs. If possible, patients should refrain from eating and drinking for 6 hours prior to the procedure and will be given medications to help them relax (i.e. moderate sedation). The procedure can be performed on both inpatients and outpatients, who typically can return to their room/home after monitoring.

Percutaneous biliary stent placement

If the common bile duct is blocked permanently and that blockage cannot be corrected with surgery or an endoscope, it can be treated with a long-term biliary drain or with an indwelling stent, which is a little metal device that keeps the narrowing open. Most patients prefer a stent to a tube, because it is completely on the inside and requires no maintenance.

After a discussion with the referring provider (usually and oncologist, hepatologist, or surgeon) a percutaneous biliary drain is placed. Then, usually on a later date, a wire is advanced through the drain into the biliary system and across the blockage. The drain is exchanged over the wire for the stent. The stent is released and expanded with a balloon. The wire can then be removed and/or a small drain can be replaced, which can be removed at a later date.

The procedure has a small risk of bleeding, infection, and damage to nearby organs. If possible, patients should refrain from eating and drinking for 6 hours prior to the procedure and will be given medications to help them relax (i.e. moderate sedation). The procedure can be performed on both inpatients and outpatients, who typically can return to their room/home after monitoring.

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