Background Information:

What are the other Names for the Procedure?

• Biliary Tract Interventions
• Imaging and Intervention of the Biliary Tract
• Percutaneous Transhepatic Biliary Interventions

What is Biliary Interventions radiology procedure? (General Explanation)

Biliary Interventions are minimally-invasive procedures that are used to treat blockages or narrowing of bile ducts.

Bile and bile ducts:

• Bile is a fluid that helps digest the fat in the food. It is produced by the liver and stored in the gallbladder
• When needed, the gallbladder releases bile in the small intestine through the bile ducts
• As bile ducts narrows or becomes blocked, bile cannot reach the small intestine and the amount of bile in blood elevates, leading to jaundice
• If there is a gallstone in the gallbladder blocking bile ducts from the gallbladder, surgery may be needed to remove the gallbladder

Biliary Interventions involves various procedures, such as the following:

Endoscopic retrograde cholangiopancreatography (ERCP):

• An optical instrument called an endoscopy is used to examine the body
• To treat blockages or narrowing;
  • Small incisions may be made in the bile duct to release the bile or small gallstones
  • A stent may be placed to keep the narrowing open
  • A catheter may be inserted to release the bile

Laparoscopic cholecystectomy:

• It is used to remove the gallbladder, in order to remove gallstones

Percutaneous cholecystostomy:

• A tube is inserted to expand the narrowed part
• It is usually used as an alternative for cholecystectomy, in patients who are very ill

Percutaneous transhepatic cholangiography (PTC):

• The contrast material is first injected to visualize the bile ducts and detect any narrowing or blockages
• If any narrowing or blockages are found, then procedures such as catheter replacement and stent replacement may be performed

What part of the Body does the Procedure involve?

Biliary Interventions involve the gallbladder, pancreas, bile ducts, liver, and lymph nodes.

Why is the Biliary Interventions radiology procedure Performed?

Biliary Interventions are performed to treat the narrowing or obstruction of bile ducts due to:

• Tumors in gallbladder, ducts, or pancreas
• Gallstones
• Infection
• Inflammation of pancreas or bile ducts
• Injury to the bile ducts

What is the Equipment used? (Description of Equipment)

Various instruments may be used for Biliary Interventions such as:

• An ultrasound imaging device
• X-ray machine
• CT scans
• Catheter: A long, thin plastic tube, about as thick as a strand of spaghetti
• Balloon: A long, thin plastic tube, with a small balloon at its end
• Stent: A small, wire mesh or plastic tube
• Endoscope: An illuminated optical instrument used to examine the inside of the body
• Laparoscope: A thin, tube-like instrument with a light and a lens for viewing the inside of the abdominal cavity

What are the Recent Advances in the Procedure?

There are no recent advances to Biliary Intervention procedures.

What is the Cost of performing the Biliary Interventions radiology procedure?

The cost of a Biliary Intervention procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding a Biliary Intervention procedure and what needs to be done.
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician.
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently.

What are some Helpful Resources?

http://www.radiologyinfo.org/en/info.cfm?pg=biliary#part_one (accessed on June 7, 2014)

http://www.ncbi.nlm.nih.gov/pubmed/21055679 (accessed on June 7, 2014)

Prior to Biliary Interventions radiology procedure:

How does the Biliary Interventions radiology procedure work?

The following may be expected during a Biliary Intervention procedure:

• In percutaneous cholecystostomy, bile is drained from the gallbladder using a tube
• Endoscopic retrograde cholangiopancreatography, takes X-ray images of the bile ducts and gallbladder
• Percutaneous transhepatic cholangiography uses a contrast material to visualize the bile ducts and takes X-ray images of bile ducts and the gallbladder
• In laparoscopic cholecystectomy, gallbladder is removed through the small incision made near the belly button (navel)

How is the Biliary Interventions radiology procedure Performed?

For all types of Biliary Intervention procedures:

• The physician may ask patients to have an MRI scan, CT scan, or an ultrasound before performing the procedure
• The patient may be given antibiotics
• Their heart rate, blood pressure, and pulse rate shall be monitored
• Typically, a nurse shall perform intravenous therapy (IV)
• The patient may be given anesthesia

During percutaneous transhepatic cholangiography:

• The needle is inserted in the liver using fluoroscopy
• The contrast material is injected and the images are taken
• If a blockage is found, a catheter may be used to release the bile

During endoscopic retrograde cholangiopancreatography:

• An endoscope is passed through the digestive tract to the duodenum of the small intestine
• A catheter is sent through the endoscope and a contrast material is injected into the biliary ducts
• X-ray images are then taken

During gallstone removal:

• A small incision is made in the bile duct
• The gallstone is removed through the incision that is made

During stent replacement:

• A balloon-tipped catheter may be used to expand the narrowed or blocked duct
• Balloon expandable stent placed over a balloon-tipped catheter is sent to the narrowed portion of the duct
• The balloon is then expanded, which puts the stent in place
• The balloon is deflated and removed after this
• The stent keeps the narrowing open

During laparoscopic cholecystectomy:

• A small incision is made near the navel/belly button
• Carbon dioxide is filled in the abdomen to provide better resolution
• Other surgical instruments are sent through additional incisions that are made
• Images are obtained through the laparoscope and using these images, the gallbladder is removed through the incision

Where is the Procedure Performed?

Biliary Interventions are performed, both as an inpatient and outpatient procedure, at a hospital.

Who Performs the Procedure?

An Interventional radiologist performs minimally-invasive Biliary Interventions procedures with imaging guidance.

How long will the Procedure take?

The interventional radiologist or physician attending to you will be able to provide information on the procedure requirement and duration.

Who interprets the Result?

An interventional radiologist interprets the results of the procedure.

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Biliary Intervention procedure:

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
• Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
• Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
• It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the X-ray
• Women should notify the physician, if they are pregnant or breastfeeding their child; as many such procedures may not be performed on pregnant women
• Depending on the procedure adopted, the patient may be asked for certain bowel or bladder preparations, before the preparation sessions
• The patient may be asked to avoid eating or drinking, several hours before the test
• The patient may be asked to stop taking any blood thinners, such as aspirin, NSAIDs, before the procedure
• The patient may be given antibiotics and blood may be drawn, in order to check the normal functioning of the kidney
• The procedure may require patients to stay overnight at the hospital

What is the Consent Process before the Procedure?

A physician will request your consent for a Biliary Intervention procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied with the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of Biliary Interventions procedures:

• These procedures may be a good alternative to an open surgery
• Recovery time is very fast, as only a small incision is made in most of the procedures and stitches are not needed

Following are the risks of Biliary Interventions procedures:

• Allergic reactions may occur due to the contrast material used in the procedure
• There may be a chance of infection due to the small incision made in the skin, but this is very rare
• Very rarely, bleeding may occur during the procedure

What are the Limitations of the Biliary Interventions radiology procedure?

Obstructions (blockage) or narrowing of the bile duct may recur, which may require Biliary Intervention procedure again or an open surgery.

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is a Biliary Intervention procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required after the procedure is performed?
• What are the costs involved?

During the Biliary Interventions radiology procedure:

What is to be expected during the Biliary Interventions radiology procedure?

The following may be expected during a Biliary Intervention procedure:

• The patient may experience a prick, due to insertion of the needle for the intravenous line
• In case of anesthesia, the patient will be unconscious throughout the procedure and monitored by an anesthesiologist
• The patient may also feel warm, due to the contrast material

What kind of Anesthesia is given, during the Procedure?

A general anesthetic is used for a Biliary Intervention procedure. The patient shall be unconscious throughout the entire procedure, and they shall be monitored by an anesthesiologist.

How much Blood will you lose, during the Procedure?

Since the procedure is minimally-invasive, blood loss involved during the procedure is minimal.

What are the possible Risks and Complications during the Biliary Interventions radiology procedure?

The following risks are possible during the procedure:

• Allergic reactions may occur due to the contrast material used in the procedure
• There may be a chance of infection due to the small incision made in the skin; even though, it is very rare
• Very rarely, bleeding may occur during the procedure

What Post-Operative Care is needed at the Healthcare Facility after the Biliary Interventions radiology procedure?

There is no postoperative care necessary after a Biliary Intervention, at the healthcare facility.

After the Biliary Interventions radiology procedure:

What is to be expected after the Biliary Interventions radiology procedure?

• The patients may be required to stay overnight at the hospital after the Biliary Intervention procedure
• They may resume their regular activities in a few days, after the procedure

When do you need to call your Physician?

Do inform your physician or healthcare provider, in case you develop an infection with symptoms such as fever, chills, nausea, and vomiting.

What Post-Operative Care is needed at Home after the Biliary Interventions radiology procedure?

• The patient should be able to resume their normal activities within a few days
• In some cases, the patient may have a catheter, exiting the side and draining bile into a bag. The duration of the drainage into a bag will vary between patients

How long does it normally take to fully recover, from the Procedure?

The patients remain in the recovery room until they are completely awake and ready to be discharged, after Biliary Interventions procedure.

Additional information:

What happens to tissue (if any), taken out during the Procedure?

Biliary Interventions procedures do not involve the removal of any body tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Biliary Interventions radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Healthcare providers or physicians who are involved in the process

The patient is advised to inquire and confirm the type of billing, before Biliary Interventions procedures are performed.