Everything about the treatment of bile duct obstruction (Biliary Drainage) in simple terms

Do your eyes and skin feel yellow? Or do you have an unbearable itch all over your body? These can sometimes be symptoms that occur when the ducts that carry the fluid called 'bile' from our liver are blocked. This fluid called 'bile' is essential for the digestive process in our body. So if this bile duct is blocked, it can back up into the liver and cause a lot of problems. Today, we are talking about a special treatment that doctors perform in such cases. It is called Biliary Drainage.

Simply put, what is this Biliary Drain?

A biliary drain is a thin, flexible tube. This tube is used to bypass the obstruction in the bile duct that connects our liver and small intestine and remove bile from the body or redirect it back to the small intestine.

Imagine a piece of garbage stuck in the middle of a water pipe. Then the water fills up in one place, the pressure increases, and the pipe can be damaged, right? That's how bile ducts are blocked. Bile accumulates in the liver. We medically call this condition cholestasis . When this happens, the condition of jaundice, which turns yellow in the eyes and skin, occurs, as mentioned earlier. Along with this, there can be severe itching all over the body.

So, what this biliary drain does is bypass the blockage and create a path for the bile to flow back through. Sometimes, this bile is collected in a bag outside the body.

What are these tube insertion methods? (Types of Biliary Drainage)

There are two main methods of this treatment. Depending on your condition, your doctor will decide which method is best for you.

1. Percutaneous Transhepatic Biliary Drainage (PTBD)

This involves inserting a thin tube (catheter) through the skin on the right side of your abdomen, through your liver, and into your bile duct. This is done using fluoroscopy, a special X-ray technique. The tube is inserted after finding the exact location of the blockage. Then, the other end of this tube is connected to a bag outside the body. The bile is then collected in that bag.

2. Endoscopic Biliary Drainage (EBD)

What happens here is that a thin tube with a camera attached, called an endoscope , is inserted through your mouth and down your food pipe to the opening of the bile duct (the beginning of the small intestine). Then, another thin tube is passed through the endoscope and inserted into the blocked bile duct to drain the bile.

This method can also be done in different ways.

• Endoscopic Nasobiliary Drainage (ENBD): Here, bile flows through a tube inserted through the nose and collects in a bag outside the body.
• Internal Stenting: This involves placing a small tube -like stent inside the blocked area and allowing bile to flow through it. This allows bile to flow directly into the small intestine, rather than leaving the body. This is the most common method.

Why would someone want to put a pipe like this?

There are many reasons why a bile duct can become blocked or blocked. This treatment is needed because of the condition called cholestasis that occurs when this happens. Let's look at the main causes.

How should you prepare before treatment?

It is very important to follow your doctor's instructions before undergoing this treatment. In general, you should be careful about these things.

• You should stop eating, drinking, and smoking at least 6 hours before the treatment . You may be allowed to drink some water, but your doctor will tell you exactly what to do.
• Tell your doctor about any allergies you have beforehand, especially to anesthetics, contrast dye used in X-rays, plastics, or metals.
• Inform your doctor about all medications and vitamins you are currently taking .
• If you are taking medications that prevent blood clotting (e.g., anticoagulants such as aspirin and warfarin), talk to your doctor about whether you need to stop them before treatment and how to do so.
• If you are pregnant or may become pregnant, be sure to inform us.
• Since you will not be able to drive after the treatment due to anesthesia, it is important to arrange for someone to drive you home in advance.

What happens during treatment?

There may be slight differences in what happens depending on the procedure you are going to have, but the doctor will explain everything to you beforehand.

How the percutaneous method (PTBD) is performed

1. First, the doctor will clean the skin on your abdomen with an antiseptic solution and numb the area.

2. Then, a thin needle is inserted through the skin into a bile duct in the liver.

3. A special liquid called contrast dye is injected to clearly see the bile duct system on the X-ray.

4. After finding the exact location of the blockage, a biliary drain tube is inserted through it and the bile is allowed to drain.

5. The outer end of the tube is pulled out of the abdominal skin and connected to a bag. The feces collect in that bag. This bag needs to be emptied several times a day.

How the endoscopic procedure (EBD) is performed

1. You will be completely anesthetized or put into a deep sleep.

2. Before inserting the endoscope through the mouth, a medicine spray is applied to the throat to numb the throat.

3. The doctor then inserts the endoscope through the mouth, passes it along the food pipe, and enters the upper part of the small intestine.

4. From there, another thin tube (catheter) is inserted through the endoscope into the blocked bile duct.

5. The blockage is then removed and the bile is allowed to drain. If a stent is being placed internally, this is done at this time. If a tube is being taken out, the tube is taken out of the nose and connected to a bag.

Are there any risks involved?

As with any medical treatment, there are risks and complications that can occur. Your doctor will inform you about all of these.

How do you take care of the pipe when you get home?

If you have a tube and bag inserted outside your body, a nurse will give you detailed instructions on how to care for it. Follow those instructions carefully.

• Drink an amount of electrolyte drinks equal to the amount of bile that is added to the bag. Your doctor will tell you what to drink and how much to drink.
• Get plenty of rest after the treatment. It's a good idea to have someone to help you the first night.
• Don't sleep with your weight on the side where the tube is . That way, there's less chance of the tube twisting.
• You can usually resume your normal activities after 24 hours, but do not lift anything heavier than 5 kg .
• Take all the medications prescribed by the doctor as prescribed .
• You can take a bath after 48 hours. However, avoid swimming in pools, the sea, or rivers completely until the tube is in place.

When should you see a doctor immediately?

If you experience any of the following symptoms, it could be a sign of an infection. So call your doctor immediately or go to the nearest hospital's Emergency Department (ETU) .

• If the pain, swelling, or redness at the site of the tube insertion increases .
• If pus or other fluid is leaking from the tube site.
• If you get a fever .

Also pay attention to these features:

• If there is new or worsening yellowing of the skin or eyes.
• If the color or smell of the feces collected in the bag suddenly changes .
• If the pipe seems to be coming loose from where it was placed.
• If you have a new stomach ache or if your existing pain gets worse.
• If vomiting continues.
• If the stomach does not empty or the air does not come out .

It's normal to feel a little scared when you hear about this type of treatment. But remember, this is to help your body get rid of the discomfort it's causing and get it back to a healthy state. Talk to your doctor about any questions or concerns you may have. He or she will explain everything to you.