What happens before a biliary drainage procedure?

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:

Your provider will clean the skin on your abdomen with an antiseptic and then numb the area with a local anesthetic.

Your provider will insert a thin needle into your skin and into a bile duct in your liver.

They’ll inject a fluoroscopic contrast dye so that they can see your bile ducts and liver on an X-ray.

Once your provider locates the blocked duct, they’ll insert the biliary drain into the bile duct to allow it to drain. You’ll likely have a catheter (small tube) sticking out from your skin.

Your provider will connect the other end of the biliary tube/drain to a bag outside your abdomen. The bile from the drain will go into the bag. (This bag will need emptying several times a day.)

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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You’ll receive general anesthesia or sedation.

A provider will numb your throat with an anesthetic spray.

Your provider will insert an endoscope into your mouth and guide it down your esophagus and through your stomach to reach the upper part of your small intestine (duodenum).

Your provider will slide a different tube, called a catheter, into the endoscope until it reaches the blocked bile duct.

Your provider will drain the blocked duct. If they’re doing internal drainage, they’ll insert a stent. If they’re doing external drainage, they’ll run a tube (catheter) from the bile duct, through your digestive tract and out of your nose. They’ll attach the tube to a bag, which will collect the bile. (This bag will need emptying several times a day.) 

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.