Biliary drainage and stenting (2021 – CME) – online course
Authors: M. Tsitskari and O. van Delden
Reviewers: A. Barnacle, E. Brountzos, P. Haslam, C. Nice and F. Wolf
This course corresponds to chapters 2.1.8 Core Procedures in Interventional Radiology and 220.127.116.11 Hepato-Pancreatico-Biliary (HPB) Intervention in the European Curriculum and Syllabus for IR.
Percutaneous transhepatic biliary drainage (PTBD) is one of the therapeutic techniques available for patients with obstructive jaundice. If endoscopy is not successful, or in cases in which an endoscopic approach is not technically feasible, a percutaneous approach to bile duct obstruction is an option. Understanding the anatomy of the liver and the biliary tree and proper evaluation of recent imaging studies is essential when performing biliary interventions. The most common indication for percutaneous biliary drainage is to decompress an obstructed biliary tree to alleviate the sequelae of bile duct obstruction like cholangitis, pruritus and jaundice.
The underlying disease is either malignancy of the bile ducts itself, or of adjacent organs or structures such as the pancreas, lymph nodes, gallbladder, or stomach. In recent years, PTBD has increasingly been employed in the management of benign biliary diseases like biliary stones or strictures, or non-surgical management of biliary leakage.
In cases that require lifelong drainage, internalisation of the drain is often required for better quality of life and fewer complications. Internalisation can be achieved with the use of stents that may be plastic, bare metallic or covered metallic. The technical success of PTBD has been reported as more than 90% and the clinical success as more than 75% depending on the indication and patient selection factors. Major complications include haemorrhage and sepsis with procedure-related mortality ranging from 0% to 3%.
- Be able to recognise normal biliary anatomy and its variants
- Integrate proper pre-procedural imaging work-up in patients with benign and malignant biliary obstruction
- Be able to understand the variety of causes of jaundice, e.g. obstructive (stone, benign and malignant, strictures, extrinsic causes) and non-obstructive (drugs, infections, autoimmune, toxic etc.)
- Be able to understand how disease processes alter anatomy and the implications for interventional strategies (e.g. level of obstruction and endoscopic vs. percutaneous approaches)
- Be able to assess the patients overall clinical status with regard to the risks and benefits of intervention
- Be aware of the appropriate post-procedural management following a biliary drainage procedure, to assess response to the intervention and recognise and manage complications including haemorrhage, infection, drain displacement
This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for IR and corresponds to chapters 2.1.8 Core Procedures in Interventional Radiology and 18.104.22.168 Hepato-Pancreatico-Biliary (HPB) Intervention.
The format of the course is interactive and easy to use, including texts, graphics, videos and a quiz to support your learning. The course duration is around one hour and is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to award 1 European CME credit (ECMEC). The CME accreditation for this course will expire on October 20, 2023. A non-CME accredited version of the course will remain available for two more years.
The enrolment period of this course is set to 90 days and may be extended throughout the year with a valid All-Access Pass.
The CME certificate will be available in the myCIRSE area past the enrolment period if the course is completed before October 20, 2023.
Release date: October 2021