Name of the Procedure:

Conversion of External Biliary Drainage Catheter to Internal-External Biliary Drainage Catheter, Percutaneous (Including Diagnostic Cholangiography and Imaging Guidance such as Fluoroscopy)

Summary

This procedure involves converting an existing external biliary drainage catheter into an internal-external drainage catheter. It is performed using a percutaneous (through the skin) approach and includes diagnostic imaging techniques like cholangiography and fluoroscopy for guidance, along with radiological supervision and interpretation.

Purpose

This procedure addresses issues related to bile drainage, often necessary for patients with obstructed bile ducts due to conditions like gallstones, tumors, or strictures. The goal is to facilitate the flow of bile from the liver into the intestine, alleviating symptoms such as jaundice, pain, and infection risk.

Indications

• Obstructive jaundice
• Bile duct strictures or stones
• Complications from previous biliary surgeries
• Malignant bile duct obstruction
• Recurrent cholangitis (bile duct infections)

Preparation

• Fasting for a certain period before the procedure, usually after midnight.
• Adjustment of medications as directed by the physician.
• Blood tests and imaging studies (e.g., ultrasound or MRI) to assess the bile ducts.

Procedure Description

1. The patient is positioned and prepped in a sterile manner.
2. Local anesthesia and possibly sedation are administered to manage pain and discomfort.
3. Using imaging guidance (e.g., fluoroscopy), the external biliary catheter is identified and accessed percutaneously.
4. Diagnostic cholangiography is performed to visualize the bile ducts and confirm the proper path.
5. The existing catheter is then converted or replaced into an internal-external drainage catheter, which will allow bile to drain both externally and internally.
6. Final imaging is conducted to ensure correct placement of the new catheter.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

The procedure is generally performed in a hospital radiology or surgical department.

Personnel

• Interventional radiologist
• Radiology technologist
• Nurses
• Anesthesiologist (if sedation is used)

Risks and Complications

• Infection at the puncture site
• Bleeding
• Injury to the bile ducts or surrounding organs
• Allergic reactions to contrast dyes used in imaging
• Rarely, bile leakage or sepsis

Benefits

• Improved bile drainage, reducing symptoms of jaundice and pain
• Lower risk of bile duct infections
• Enhanced quality of life

Recovery

• Observation for a few hours or overnight in the hospital.
• Instructions on catheter care and potential signs of complications to watch for.
• Pain management with prescribed medications.
• Follow-up appointments to monitor catheter function and overall condition.

Alternatives

• Surgical bile duct bypass
• Endoscopic stenting
• Continued external catheter drainage

Each alternative has its own risks and benefits, which should be discussed with the healthcare provider.

Patient Experience

During the procedure, patients might feel some pressure or discomfort when the catheter is manipulated, but pain management measures will be in place. Afterward, there could be mild soreness at the insertion site, managed with pain medication. Patients are usually able to return to normal activities within a few days, with some minor restrictions until fully recovered.