Biliary Intervention in Cyprus
Bile is produced in the liver and drains to the gut through internal tubes (bile ducts). Bile can accumulate in the liver if there is disruption to normal flow from the liver to the gut either due to blockage of the bile ducts or because of a leak.
Accumulation of bile is abnormal and if left untreated it can cause the following:
- Jaundice (yellow skin and eyes)
- Pruritus (itchy skin)
- Biliary Sepsis (infection)
- Liver Failure
Percutaneous transhepatic biliary drainage is a procedure in which Dr Zertalis uses ultrasound (US) and X-Rays (fluoroscopy) to insert a small plastic tube (drain) into the liver (transhepatic) through the skin (percutaneously) to allow drainage of bile either externally (outside the body) into a bag or internally into the gut.
In transhepatic biliary stenting, a metal or plastic stent (flexible scaffold tube) is passed through the same opening in the liver and positioned across the blocked bile duct to keep it open. This is often done after percutaneous biliary drainage to allow the external drain and bag to be removed.
Transhepatic biliary drainage and stent involves taking a picture of the bile ducts to identify where the blockage might be. This is known as a percutaneous transhepatic cholangiogram (PTC).
In addition to blood tests that you probably have had performed, imaging investigations such as an ultrasound scan, a computed tomography (CT) scan or a magnetic resonance (MR) scan would have demonstrated a blockage or leak within your bile ducts.
Regardless of the cause of the blockage or leak, biliary intervention aims at draining bile either externally (outside the body) into a bag or internally into the gut by placing a drain or stent. Benefits include symptomatic relief of jaundice & pruritus, treatment of biliary sepsis and preservation of normal liver function by preventing liver failure.
PTC, drainage & stenting are safe, effective and accurate procedures, but as with any medical procedure there are some risks and complications that you may uncommonly experience.
Bleeding: Significant bleeding requiring treatment is rare. Uncommonly, a blood transfusion may be required and rarely an interventional radiological or surgical procedure may be necessary to stop ongoing bleeding.
Infection: This is an uncommon complication. You will be given antibiotics before the procedure and you will be monitored during and after the procedure to check for signs of infection.
Allergy to contrast (X-ray dye): Adverse events are uncommon, mild and can be managed safely in our department. A major life-threatening contrast reaction is rare (< 0.005%).
Kidney Impairment: Impairment of kidney function can occur due to the contrast (X-ray dye) or dehydration. You will have a drip placed before the procedure to ensure adequate hydration and to minimise the risk of problems with kidney function.
Radiation Risk: Immediate harmful effects such as skin burns, or radiation sickness are extremely rare. The radiation dose you receive during the procedure is monitored to prevent this. On rare occasions the procedure will have to be stopped if the threshold for immediate harmful effects is reached. Increase in lifetime risk of cancer due to radiation per examination is also rare (< 0.001%).
Failure: Very rarely, Dr Zertalis will be unable to place the drain or stent satisfactorily in the liver. If this happens, you may require either a repeat procedure or a small operation to overcome the blockage. The drain or stent can move out of position or become blocked. Removal, replacement and insertion of a new drain or stent may become necessary.
Dr Zertalis will explain the procedure and ask you to sign a consent form. Please feel free to ask any questions that you may have and remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
Before the procedure
Relevant bloods test will be undertaken before the procedure and if your blood clotting is abnormal, blood transfusion may be necessary to correct this. If you have any concerns about having a blood transfusion, you should discuss these with Dr Zertalis.
The procedure is performed with local anaesthetic and sedation. You will be asked not to eat or drink for 6 hours before the procedure. A short and thin plastic tube (cannula) will be placed into a vein in your arm.
Please let Dr Zertalis know about any medications you take, any allergies you may have and if you previously have had a reaction to the x-ray dye (contrast).
You will be asked to change into a hospital gown and lie on your back. You will have devices attached to your chest, arm and finger to monitor you pulse, blood pressure and oxygen levels. You will be given a sedative to relieve anxiety and painkillers where necessary. This is standard for all minimally invasive interventional radiology procedures performed in Cyprus.
The procedure is performed under sterile conditions and Dr Zertalis will wear sterile gowns and gloves to carry out the procedure. The skin near the point of insertion will be swabbed with antiseptic and you will be covered with sterile drapes.
Your skin near the point of insertion will be numbed using local anaesthetic. When the local anaesthetic is injected you will likely experience a burning sensation for 30 to 60 seconds.
Using ultrasound and X-rays (fluoroscopy), Dr Zertalis will first guide a needle and then a wire into one of the bile ducts. This may be done in the lower right side of your chest or through the skin of your upper abdomen. Once the wire is in position, Dr Zertalis will slide a number of small tubes over the wire to make the path big enough so that the drainage tube can be inserted over the wire into position. The drain will be fixed to the skin with sutures and sterile dressings.
If you have a biliary drain in place already, a wire will be passed through the drain into the gut, the drain removed over the wire and replaced with the stent. If you do not have a biliary drain in place,a bile duct will be accessed as described above to place the stent.
Dr Zertalis will use a balloon to expand the stent and you may experience a sharp pain in your abdomen for a short period of time while the balloon is inflated. This can be well controlled with sedation and painkillers. After the procedure, a sterile dressing is applied at the entry site.
Every patient is different, however, expect to be in the radiology department for up to 1 hour.
After the procedure
You will be transferred to your ward where your pulse, blood pressure, oxygen levels and the entry site in the skin will be checked by our team at regular intervals. You should expect to be in bed for up to 6 hours and to stay in hospital as inpatient.
With regards to length of hospital stay, how long the drain will stay in and follow-up, it all depends on why you need the drain and/or stent in the first place. You will need to discuss this with Dr Zertalis