Name of the Procedure:

Endoluminal biopsy(ies) of the biliary tree, percutaneous, any method(s) (e.g., brush, forceps, and/or needle), including imaging guidance (e.g., fluoroscopy), and all associated radiological supervision and interpretation, single or multiple.

Summary

This procedure involves using various methods, such as a brush, forceps, or needle, to collect tissue samples from the biliary ducts through the skin. It uses imaging guidance, like fluoroscopy, to ensure accuracy and safety. The collected samples are then examined for any signs of disease or abnormality.

Purpose

The procedure is performed to diagnose conditions affecting the biliary tree, such as blockages, strictures, or cancer. The goal is to obtain tissue samples to accurately diagnose these conditions and guide appropriate treatment.

Indications

• Persistent jaundice or unexplained abnormal liver function tests.
• Suspected bile duct obstructions or strictures.
• Suspected cholangiocarcinoma (bile duct cancer).
• Unexplained biliary tree abnormalities detected in imaging studies.

Preparation

• Patients may be advised to fast for several hours before the procedure.
• Adjustments to certain medications (e.g., blood thinners) might be necessary.
• Pre-procedure diagnostic tests, such as blood tests and imaging studies, will likely be required.

Procedure Description

1. The patient is positioned appropriately, and the skin is cleaned and sterilized.
2. Local anesthesia is administered to numb the area.
3. A small incision is made, and a needle is inserted into the biliary tree under imaging guidance.
4. Biopsy tools (brush, forceps, or needle) are introduced to collect tissue samples.
5. The samples are retrieved, and the instruments are withdrawn.
6. The incision site is dressed.

Duration

The procedure typically takes between 30 minutes to an hour.

Setting

The procedure is usually performed in a hospital or an outpatient surgical center with appropriate imaging facilities.

Personnel

• Interventional radiologist or gastroenterologist
• Radiology technicians
• Nurses
• Anesthesiologists (if sedation beyond local anesthesia is required)

Risks and Complications

• Infection
• Bleeding
• Injury to the biliary ducts or surrounding organs
• Pancreatitis
• Adverse reactions to anesthesia or contrast agents

Benefits

• Accurate diagnosis of biliary conditions, leading to appropriate and targeted treatment.
• Minimally invasive compared to surgical biopsy methods.
• Shorter recovery time and fewer risks compared to more invasive procedures.

Recovery

• Patients may need to stay for observation for a few hours post-procedure.
• Instructions will be provided regarding wound care and any activity restrictions.
• Follow-up appointments will be scheduled to review biopsy results and plan further treatment.

Alternatives

• Endoscopic retrograde cholangiopancreatography (ERCP) with biopsy.
• Surgical biopsy of the biliary ducts.
• Imaging studies alone (though they may not provide definitive diagnosis).

Patient Experience

• Patients may feel some pressure or mild discomfort during the procedure.
• Post-procedure, there may be minor soreness at the incision site.
• Pain is typically managed with over-the-counter pain relief medications.
• Most patients can resume normal activities within a day, following the specific advice of their healthcare provider.