Name of the Procedure:

Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; internal-external.

Summary

In this minimally invasive procedure, a catheter is placed into the bile ducts through the skin to allow for bile drainage. This is often guided by imaging techniques such as ultrasound or fluoroscopy. The procedure also includes diagnostic cholangiography, which involves taking images of the bile ducts to identify blockages or other issues.

Purpose

The primary purpose is to relieve obstruction in the bile ducts, which can cause severe pain and jaundice. It also aims to diagnose and provide a pathway for the treatment of biliary diseases.

Indications

• Obstructive jaundice
• Bile duct stones
• Biliary strictures
• Biliary leaks
• Pancreatic cancer
• Gallbladder cancer
• Cholangitis
• Bile duct injury after surgery

Preparation

• Patients may need to fast for several hours before the procedure.
• Blood tests and imaging studies like ultrasound or MRCP might be required beforehand.
• Review and adjustment of current medications, especially blood thinners.

Procedure Description

1. The patient lies on an imaging table.
2. Local anesthesia and possibly sedation are administered.
3. Using ultrasound or fluoroscopy, a needle is inserted into the bile duct.
4. Contrast dye may be injected to perform a cholangiography.
5. A guidewire is passed through the needle into the bile duct.
6. Over the guidewire, a catheter is placed that allows bile to drain internally (into the digestive tract) and externally (into a collection bag).
7. The external catheter is secured and connected to a drainage bag.

Duration

The procedure usually takes 1-2 hours.

Setting

The procedure is typically performed in a hospital's interventional radiology suite.

Personnel

• Interventional radiologist
• Radiologic technologists
• Nurses
• Anesthesiologist (if sedation is required)

Risks and Complications

• Infection
• Bleeding
• Injury to nearby organs
• Catheter displacement or blockage
• Allergic reaction to contrast dye
• Pain at the insertion site

Benefits

• Relief from symptoms like jaundice and abdominal pain.
• Improved liver function.
• Provides diagnostic information and a pathway for further treatment.
• Benefits usually realized within a few days.

Recovery

• Close monitoring in the recovery area for a few hours.
• Instructions for catheter care at home.
• Pain management with prescribed medications.
• Follow-up appointments to check catheter function and position.
• Limited physical activities to avoid dislodging the catheter.

Alternatives

• Endoscopic retrograde cholangiopancreatography (ERCP)
• Surgical bile duct drainage
• Watchful waiting in non-acute cases

Pros and Cons of Alternatives

• ERCP: Less invasive but not suitable for all patients and situations.
• Surgical drainage: More definitive but involves longer recovery and higher risk.
• Watchful waiting: Low risk in certain scenarios but doesn't address acute symptoms.

Patient Experience

During the procedure, the patient may feel pressure or mild discomfort from the needle insertion and manipulation. Post-procedure, slight soreness at the insertion site is common. Pain management is typically effective with oral medications. The patient will need to manage the external catheter and drainage bag, following specific care instructions to prevent infection and displacement.