Biliary Drainage: Why and How Is It Done?

Are your eyes and skin turning yellow and your whole body itching unbearably? These are the symptoms of what we all know as jaundice. Most of the time, the cause of this is a blockage in the bile duct, which is a fluid that comes from our liver and helps in digestion. When this is blocked, that fluid backs up into the liver, causing the yellowing and itching. So, a special treatment method that doctors use in such cases is called Biliary Drainage. Simply put, this involves inserting a small tube into the blocked bile duct and allowing the bile to drain out. Let's talk about this in detail today.

What is Biliary Drainage? Are there any types?

Biliary Drainage is a procedure that uses a flexible, thin tube (catheter) to allow bile to flow through a blockage in the bile duct, which runs from the liver to the small intestine. It is like creating a new path for a blocked waterway. This is done in two main ways. Your doctor will decide which method is best for you based on your condition.

What is stent placement?

In some cases, especially if the blockage is permanent (for example, due to cancer), your doctor may permanently place a small mesh-like tube, called a stent, inside your bile duct to keep it open. This is usually done a few days after the initial tube is placed.

Why would someone need this kind of treatment?

The main reason for needing this treatment is a blockage or narrowing of the bile duct (`stricture`). This causes bile fluid to accumulate in the liver (`cholestasis`). Imagine, something like when a drain pipe in our house gets clogged, water accumulates here. There can be several reasons for bile duct blockage:

• Stones in the gallbladder or bile ducts (choledocholithiasis).
• Pancreatitis or pancreatic cancer .
• Bile duct cancer (Cholangiocarcinoma).
• Liver cancer or gallbladder cancer.
• Swelling of lymph nodes near the liver or pancreas due to cancer.
• Some parasitic infections .
• Damage to the bile ducts during other surgery.
• Long-term inflammatory conditions of the bile ducts, such as `primary sclerosing cholangitis`.

How do you prepare before treatment?

There are a few things you need to do before this treatment. Your doctor will give you clear instructions about this. It is very important to follow those instructions exactly. 1. Food and Drink: You should stop eating, drinking, and smoking at least 6 hours before the treatment. Your doctor may tell you when you can drink fluids, such as water. 2. Allergies: Be sure to tell your doctor about any allergies you have, especially to anesthetics, contrast dye used in X-rays, or to plastics or metals. 3. Medications:Tell your doctor about all the medications you are currently taking (including vitamins). Especially if you are taking blood thinners (anticoagulants) such as aspirin and warfarin, ask if you need to stop taking them and when. 4. Pregnancy: Be sure to tell your doctor if you are pregnant or may become pregnant. 5. Driving: You will not be able to drive after the treatment because you will be under anesthesia. So plan to bring someone to take you home.

What happens during treatment?

The steps for this will vary slightly depending on the procedure you are having (PTBD or EBD). But don't worry, your doctor will explain everything to you beforehand.

How the percutaneous method (PTBD) is performed:

• First, the skin on your stomach is cleaned and the area is numbed.
• The doctor then inserts a small needle through the skin into a bile duct in the liver.
• A special liquid (contrast dye) is injected to make the X-rays visible.
• Once the exact location of the blockage is found, the drainage tube is inserted into that area and the bile fluid is allowed to drain.
• The other end of this tube comes out of your skin and is connected to a bag on the outside. The bile fluid collects in this bag. (This bag needs to be emptied several times a day.)

How the endoscopic procedure (EBD) is performed:

• In this, you will be given general anesthesia or light anesthesia, so you will not feel anything.
• Your throat is tingling.
• The doctor inserts a tube with a camera (endoscope) through the mouth, passes it along the food pipe, and guides it to the location of the bile duct.
• Then, another tube (catheter) is passed through that tube and passed through the blocked duct to allow bile to flow.
• If the phlegm is removed externally, a tube is inserted through the nose and attached to a bag. If it is removed internally, a stent is placed inside.

Risks and care after treatment

As with any medical treatment, there are risks and complications that can occur.

• Possible complications:
• Accidental loosening, twisting, or blockage of the inserted tube.
• Pain or discomfort.
• Infection (the doctor will prescribe antibiotics to prevent this).
• Bleeding.
• Changes in the body's electrolyte composition (`Electrolyte abnormalities`).
• Very rarely, lung problems (`Pneumothorax`) may occur.

The doctor will clearly explain these risks to you and advise you on what to do if any problems arise.

How to take care of yourself at home?

If you have a tube and bag inserted outside your body, the nursing staff will teach you how to care for it.

• Do not sleep with your weight on the side where the tube is. This can cause the tube to twist.
• If your doctor advises you to flush the tube with a little saline solution daily, do so.
• Drink electrolyte drinks to match the amount of fluid coming out of the bag. Ask your doctor what to drink and how much to drink.
• You can take a shower 48 hours after the treatment. However, do not go swimming in pools or the sea/river while the tube is in place.
• Avoid lifting weights until your doctor tells you to.

When should you seek immediate medical attention?

If you experience any of the following symptoms, call your doctor immediately, or go to the Emergency Department (ETU) of the nearest hospital.

• Fever .
• If there is increasing pain, swelling, or redness at the site of the tube insertion.
• If pus or other fluid is draining from the tube site.
• If stomach pain increases or occurs again.
• If the skin or eyes turn yellow again.
• If you are vomiting.
• If the pipe seems to be coming loose.
• If stool does not pass or air does not pass.

Biliary drainage is a very effective treatment for bile duct obstruction. Your medical team will help you choose the best option for your condition. Feel free to ask them any questions or concerns you may have. Biliary Drainage, Bile Duct Obstruction, Jaundice, PTBD, EBD, Liver Diseases, Gallstones, Sinhala medical article