Biliary Drainage & Stenting
When the bile ducts are blocked, bile backs up into the blood and causes jaundice, itching and, if it becomes infected, life-threatening cholangitis. If the blockage cannot be relieved by endoscopy (ERCP), a fine tube can be placed through the skin into the ducts under ultrasound and X-ray guidance to drain them, and a stent can then be placed to hold the duct open.
Dr. Mohamed El Ghobashy · Consultant Interventional Radiologist
What it treats
- •Obstructive jaundice caused by pancreatic, bile duct or gallbladder tumours
- •Blocked ducts where ERCP has failed or is not anatomically possible
- •Cholangitis — infected, obstructed bile — as an urgent decompression
- •Bile leaks or strictures following gallbladder or liver surgery
- •Decompression before planned surgery or chemotherapy
Who is a candidate?
- Patients with dilated bile ducts on ultrasound, CT or MRCP
- Patients in whom ERCP has failed, or whose anatomy makes it impossible
- Patients who are too unwell for surgery and need the obstruction relieved quickly
- Patients needing bilirubin lowered before chemotherapy can start
How the procedure works
- 1
Imaging review
Ultrasound, CT or MRCP show the level of the blockage and which ducts are dilated, which determines the safest approach.
- 2
Puncture
Under local anaesthetic and sedation, a fine needle is passed through the skin into a bile duct using ultrasound and X-ray guidance.
- 3
Drainage
Contrast confirms the anatomy and a soft drainage catheter is placed across or above the blockage, immediately decompressing the system.
- 4
Stenting
Once infection and jaundice have settled, a metal or plastic stent can be placed at a second sitting so the duct stays open and the external tube can often be removed.
Recovery
Jaundice and itching usually begin to improve within days as bilirubin falls. If an external drain is left in place, you will be shown how to care for the bag and the site, and it is flushed regularly. Most external drains are internalised or removed once a stent is working. Antibiotics are given when infection was present.
Discuss this procedure
Private consultations and procedures are at Andalusia Hospitals, Maadi. Kasr Al-Ainy is Dr. El Ghobashy's academic post at Cairo University and does not take private cases.
Frequently asked questions
How is this different from ERCP?
ERCP reaches the bile ducts from inside the gut with an endoscope. The percutaneous route reaches them from outside, through the skin and liver. It is the standard option when ERCP has failed or when surgery has changed the anatomy so the endoscope cannot get there.
Will I have to live with a bag?
Often not. An external drain is frequently a temporary measure to decompress an infected or severely obstructed system; once things settle a stent is placed internally and the external tube can usually be removed.
Does this treat the cancer causing the blockage?
No — it treats the obstruction, not the tumour. Relieving jaundice is often what makes chemotherapy or surgery possible, so it is usually one part of a plan agreed with the oncology team.
Other procedures
This page is general information, not medical advice for an individual. Whether a procedure suits you depends on your imaging, your history and an in-person assessment.