Overview

This information is about having a minimally invasive procedure through the skin to drain blocked bile ducts. The procedure is called percutaneous biliary drainage.

The liver makes a liquid called bile. Your bile ducts are thin tubes that carry bile from the liver to the small bowel. Here, bile helps your body to digest fat.

If your bile ducts get blocked for any reason, this can cause troublesome symptoms. Percutaneous biliary drainage is a specialised procedure that allows bile to drain out of the body.

The aim of this information is to help answer some of your questions about having percutaneous biliary drainage. It explains:

• the benefits of the procedure 
• the risks of the procedure 
• how to prepare for the procedure 
• what happens during the procedure 
• what happens after the procedure 

If you have any more questions, please speak to a doctor or nurse caring for you in the interventional radiology (IR) department.

About bile and the bile ducts

Your liver continuously makes a golden yellow or dark green fluid called bile.

Usually, bile passes out of the liver through a series of tubes called the bile ducts. It is then stored in a small, pouch-like organ called the gallbladder. This is attached to the bottom of the liver.

Bile is released from the gallbladder down a single larger tube (common bile duct) into the small bowel. Here, it plays an important role in helping your body to digest food.

Causes of blocked bile ducts

There are different possible causes of blocked bile ducts. These include non-cancerous (benign) and cancerous (malignant) causes.

Common benign causes are:

• gallstones (small stones that form in the gallbladder)
• previous liver surgery

Common malignant causes are:

• liver cancer 
• bile duct cancer (cholangiocarcinoma)  

Symptoms of blocked bile ducts

Bile usually drains into the small bowel.

If bile cannot drain into the small bowel, it will build up and lead to a condition called jaundice. This can cause:

• your skin and the whites of your eyes to turn yellow
• itching
• discomfort
• a lack of energy

Eventually, your liver may not work so well if you have jaundice. 

If your blocked bile ducts get infected (cholangitis), you can become unwell with high temperatures and shaking. Your vomit, poo and urine may also become a different colour.

Percutaneous biliary drainage allows bile to drain out of the body and helps to improve the symptoms of blocked bile ducts.

About percutaneous biliary drainage

Percutaneous biliary drainage is a specialised procedure. It allows the blocked bile ducts to be drained directly through the skin over the liver and out of the body.  

We do the procedure at an operating theatre in the interventional radiology (IR) department using ultrasound and X-rays. Interventional radiology is when we use medical imaging guidance to do minimally invasive procedures.

What interventional radiologists do

Interventional radiologists (IR doctors) do minimally invasive, image-guided procedures on different parts of the body. They use imaging machines, such as X-ray or ultrasound guidance, to show them exactly where to go inside the body. This avoids the need for large surgical cuts (incisions).

Most IR procedures are done through the skin using a small needle.

Interventional radiology (IR) procedures are very safe. This is because the IR doctors can clearly see important structures of the body in real time.

IR doctors work in a team with specialist nurses and radiographers (health professionals who specialise in medical imaging). The whole team looks after you during your procedure and recovery.

Benefits of the procedure

Percutaneous biliary drainage is a minimally invasive treatment for blocked bile ducts.

The procedure is a safe way to drain blocked bile ducts.

Risks of the procedure

Serious complications are rare after percutaneous biliary drainage. However, as with any procedure, there are some risks involved. The IR doctor explains these risks before asking for your permission (consent) to do the procedure.

The most common risks are listed in this section.

Infection

It is possible to get an infection in the liver or blood. We give you antibiotics before the procedure to help prevent this.

If you already have an infection, the drainage will help to improve your symptoms.

Bleeding

In rare cases, there can be bleeding from the liver or bile duct. This usually stops by itself. Sometimes, the IR doctor may need to give you treatment to stop the bleeding.

Bile leak or infection of the tummy lining (peritonitis)

Bile can irritate and damage the skin around the drain. In rare cases, some bile may leak into the lining of the tummy (peritoneum) and cause an infection (peritonitis).

It is rare to have a lot of bile leakage, but this can be painful. If this happens, you may need more drains or surgery.

Radiation risks

During the procedure, you are exposed to X-rays. They are a type of radiation called ionising radiation. This may cause cancer many years or decades after you are exposed to it.

You might have some skin redness after the procedure that feels like sunburn. We do not expect this to be permanent. The redness might be harder to notice on brown and black skin. 

Interventional radiology (IR) is when we use medical imaging guidance to do minimally invasive procedures. The amount (dose) of radiation from these procedures is generally low. More complex procedures might involve a medium (moderate) dose of radiation.

The IR doctor and radiographer make sure that:

• your radiation dose is kept as low as possible
• the benefits of having X-rays during your procedure are greater than the radiation risks

Radiation and pregnancy

Radiation can be harmful for an unborn baby. If you are or think that you might be pregnant, it is important to tell a member of your medical team before the procedure. We cannot do any procedure that involves radiation if you are pregnant.
 
If you can become pregnant from sex, you need to use protection (contraception) from the first day of your period until your appointment. This means that you will not be pregnant when you have the procedure.

If the first day of your period has already passed, please contact the interventional radiology (IR) department. We can then give you another appointment within the first 10 days of your period. 

We ask you to sign a pregnancy declaration form before the procedure.

Other treatment options

Your doctor has recommended percutaneous biliary drainage as the best option for you.

It is sometimes possible for us to do endoscopic drainage. This is when we drain your blocked bile ducts using a special telescope through the mouth. However, endoscopic drainage is not an option for everyone. It is unsuitable for some types of bile duct blockage.

You may have been offered a percutaneous biliary drainage procedure if we have already tried endoscopic drainage and it did not work.