About the Procedure
The liver works like a large factory in the body. It stores sugar in the body, acts as a de- toxic device and also manufactures bile. The bile that is manufactured drains into the intestine through a system of tubes all the biliary radicals
These ducts can be blocked either by tumor, a stone or a benign stricture. Most of these lesions are treated through an endoscope. However, there is situations where an endoscopic procedure fails and then an interventional radiology procedure may provide the answer.
Procedures Details
Biliary drainage procedures
The liver works like a large factory in the body. It stores sugar in the body, acts as a de- toxic device and also manufactures bile. The bile that is manufactured drains into the intestine through a system of tubes all the biliary radicals. The right and left biliary radicals joined together to form the hepatic duct this duct receives the bile that was collected and stored in the gallbladder and continues as the common bile duct.
These ducts can be blocked either by tumor, a stone or a benign stricture. Most of these lesions are treated through an endoscope. However, there is situations where an endoscopic procedure fails and then an interventional radiology procedure may provide the answer.
The procedure starts by puncturing a radical in the liver under image guidance most commonly from the side of the chest. Once a radical is punctured the biliary system is opacified by injection of a medical dye [contrast]. These images gives an accurate idea about the underlying condition, the length of the block and also tells us if treatment is feasible at all.
The next step would be to bypass the block or the narrowed segment. Another puncture is made under image guidance so that a radical [ biliary duct] that is ideally suitable for the procedure is accessed. Through the needle that is used for the puncture a wire is passed to the level of the obstruction. This wire is then slowly navigated across the occluded segment into the small intestine through the opening of the common bile duct. Once this is achieved the segment that is diseased is dilated with a balloon and a plastic tube placed in in such a way that there are multiple holes within the intestine and also in the radicals of the liver which are above the diseased segment. Now bile Check-Flo through the tube into the intestine. This procedure is called a internal-external drainage procedure. The problem in this procedure is that a segment of the tube will be outside the body which may prove extremely uncomfortable to the patient.
The next step would be to convert this tube into a totally internal bypass procedure. This is done by exchanging the tube for a metal mesh which called a stent, this will allow the flow of bile and help the patient recover from the symptoms of jaundice.
The long-term benefits of this procedure would depend upon the underlying disease. If it is a cancer the acute may get blocked in the next several months and the procedure may have to be repeated.
Complications
Since many of these patients are extremely sick and they may have associated problems with normal clotting of blood the procedures has a small but definite risk of bleeding which can rarely be fatal.
There is also a chance of a failed procedure especially in the biliary radicles are not dilated.