Biliary drainage and stenting (2021) – online course

Description

Authors: M. Tsitskari and O. van Delden

Reviewers: A. Barnacle, E. Brountzos, P. Haslam, C. Nice and F. Wolf

This course corresponds to chapters 2.1.9 Core procedures in interventional radiology and 2.2.2.5 Hepato-pancreatico-biliary (HPB) intervention in the European Curriculum and Syllabus for Interventional Radiology.

Abstract

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%.

Learning objectives

• 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

Further information

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 Interventional Radiology and corresponds to chapters 2.1.9 Core procedures in interventional radiology and 2.2.2.5 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.

The enrolment period of this course is linked to the validity of the All-Access Pass.

Release date: October 2021