Healthcare providers use biliary drains to unblock bile ducts. Several conditions may require a biliary drain. And there are multiple biliary drainage procedure approaches based on the reason for it and your specific needs.
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A biliary drain is a thin, flexible tube with several small holes along the sides. Healthcare providers use biliary drains when bile (a fluid that helps with digestion) can’t drain well from the bile duct that connects your liver to your small intestine.
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If something is blocking this duct, bile can back up into your liver (cholestasis). This can cause jaundice, which can give your skin and the white of your eyes a yellow hue. It can cause widespread itchiness as well.
When there’s a bile duct blockage, a biliary drain helps bile flow from your liver into your small intestine. Depending on the type of biliary tube, it may drain to a bag outside your body.
There are two main types of biliary drainage:
This type of drainage goes through your skin (percutaneous) in your abdomen, through your liver to your bile duct and then into your duodenum (beginning of your small intestine). The bile then drains through a tube (catheter) and into a bag outside your body and also into your intestine.
Providers use an imaging procedure called fluoroscopy to see the blocked duct and place the catheter.
During an EBD procedure, a provider uses an endoscope (a medical device with a light on the end) and inserts it into your mouth and down your digestive tract until it reaches your bile duct. They then insert a catheter into the scope and into your blocked bile duct to drain it.
Providers may use ultrasound guidance (endoscopic ultrasound-guided biliary drainage), or they may do it with endoscopic retrograde cholangiopancreatography (ERCP).
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The bile drainage can exit your body through a tube out of your nose (endoscopic nasobiliary drainage, or ENBD). Or it can involve internal drainage. With internal drainage, your provider places a stent placed via an endoscope that helps drainage of bile from the liver to the intestine.
Depending on the cause of the blockage, your provider may place a permanent stent across the site of the bile duct blockage. They may do this a couple of days after the initial drainage procedure.
The most common reason for needing a biliary drain is a blockage or narrowing (stricture) of a bile duct. This leads to cholestasis, which is the slowing or stalling of bile flow from your liver.
Several conditions can cause a bile duct blockage and cholestasis, including:
Preparation for a biliary drainage procedure depends on many factors, like the type of procedure you’re getting and the reason for it. Follow your healthcare provider’s instructions on steps to take before the procedure. Generally, you should:
You won’t be able to drive yourself home after the procedure due to the anesthesia you receive, so you’ll need to make plans to have someone else drive you home after it.
The steps of a biliary drainage procedure vary based on the type you’re getting and the reason for it. Your healthcare provider will walk you through the steps before the procedure. Let them know if you have any questions or concerns.
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The general steps of a percutaneous biliary drainage (PTBD) procedure include:
You may eventually be able to remove the external bag and cap the outward drainage tube. Your provider will let you know if this is a possibility. If so, you’ll need to flush the drain with a small amount of normal saline (sterile medical salt water) daily as instructed.
There are many ways to perform endoscopic biliary drainage (EBD). And providers use different kinds of imaging guidance depending on your unique situation. The general steps of an endoscopic biliary drainage procedure include:
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A biliary drainage procedure is usually an outpatient procedure, which usually means you’ll go home the same day or the next day. Right after the procedure, you’ll go to an observation room where providers will check on you for a few hours to make sure you don’t have any side effects or complications.
If you have a catheter and drainage bag, a nurse will teach you how to care for the catheter at home, like how to empty the bag and change the dressing.
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Both types of biliary drainage procedures have disadvantages and possible complications, including:
Other complications related to PTBD include:
Early complications of biliary stenting include:
Other complications of biliary stents can include:
Your healthcare provider will go over these risks and possible complications with you. They’ll let you know what signs and symptoms to look out for after the procedure.
If you have an external drainage tube, your healthcare team will give you specific instructions on how to take care of it at home. Be sure to follow them and ask questions if you’re uncertain about something. Here are some things to take note of after a biliary drainage procedure:
Call your healthcare provider or seek immediate medical care if you have symptoms of infection, like:
Also, see your provider if:
A note from Cleveland Clinic
Biliary drains help return a healthy flow of bile. There are multiple approaches to this procedure. Know that your healthcare team will work with you to determine which one is best for you. Don’t hesitate to ask questions or voice any concerns. They’re there to help and guide you.
Last reviewed on 11/17/2023.
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