Biliary Interventions


The most common biliary intervention performed in our department is biliary drainage.

This is done in cases of obstruction of the bile ducts that may be due to malignancy or benign disease.


Procedure:

The procedure is done under general anesthetic.

A thin needle is placed through the skin and liver into a bile duct under ultrasound guidance. Iodine contrast is injected through the needle and radiographs are obtained to demonstrate the bile ducts as well as the location and appearance of the obstructing lesion. A guide wire is then placed over the narrowed segment into the small intestine.

We can then place a metallic stent or a plastic drainage tube over the obstructing lesion.





Metallic Biliary Stenting

This is placement of a permanent metallic stent between the bile ducts and the small intestine (duodenum), usually used in the context of proven and inoperable malignancy where this is a palliative procedure to facilitate drainage of bile and alleviate symptoms of obstructive jaundice.

This is very convenient as there is no post procedure wound care but patients should contact the treating doctor if jaundice recurs.

Advantages of metalic stents:

There is no external component and no wound care is required.

Disadvantage:

Occlusion of the stent is difficult to manage and requires endoscopic removal. If tumor grows through the stent it may be impossible to remove.




Endo Exo Biliary Prosthesis

This is a plastic drainage tube that is placed through the skin, traversing the liver and bile ducts with the distal end in the duodenum.

There are multiple side holes in the tube that enable bile to drain from the bile ducts into the small intestine.

The proximal end remains outside the body where it is adhered to the skin. No external drainage occurs and the proximal tube allows future access as well as flushing of the tube.





Advantages of Endo Exo Drainage

In the event of occlusion / blockage the tube can easily be flushed or replaced.


Disadvantages:

The external tube with the dressing is inconvenient and does require replacement of dressings from time to time.

Inefficient forward drainage or obstruction may result external bile drainage.

The plastic tube needs to be replaced every six weeks to prevent infection.


Endo/exo tube wound care:

Endo/exo drainage tubes are used to aid bile drainage into the intestines due to a narrowing that stops the bile from draining naturally.

Steps to follow to prevent blockage of the endo/exo tubes and wound infection:-

Procedure

Bile drainage could be green, yellow or brown in colour and may have an offensive smell

The following procedure should be carried out if drainage is noted on the wound dressing & to prevent blockage of the drainage tube:-

Aseptic technique to be used (using sterile gloves & a clean work surface)

The patient will have one or two endo/exo tubes inserted

Carefully remove the tegaderms and gauze

A butterfly, skater fix or revolution has been used to secure the drainage tube.(Do not remove or loosen it from the skin this device can only be obtained from our intervention unit.) Do not pull on the tube as there are no stitches keeping it in place. If the device has come loose due to excessive bile drainage, carefully clean area and secure the tube with plasters and contact the intervention unit

Clean the skin around the point of tube entry with hibitane and water (available at the pharmacy)

Flush the drainage tube once a week inject 10ml sterile water very slowly into the tube. Never attempt to draw back on the syringe. (Freshly boiled water that has been allowed to cool down may be used if sterile water is not available)

Secure the drainage tube with gauze & tegaderms (size 1628 available at the pharmacy, if the size is not available 4 size 1626 can be used)

If there is any difficulty in flushing the tubes do not continue. Secure the tube & contact our unit for assistance 012-664-8844

If the skin is red, peeling & irritated Cavilon spray which is a skin protective barrier that can be purchased at the pharmacy and be sprayed after cleaning & before the plaster is stuck down