What is bile?

Bile is made and released by the liver. Bile moves through a network of tube-like structures called bile ducts to the small intestine, where it helps the body break down and absorb food, and then out of the body through the digestive system. The common bile duct connects the liver, gallbladder and pancreas to the small intestine.

What is a biliary drain?

A biliary drain (also called a biliary stent) is a thin, hollow, flexible tube with several small holes along the sides. A biliary drain is used when too much bile collects in the bile ducts.

If something is blocking the bile duct, bile can back up into the liver. This can cause jaundice, a condition in which the skin and white of the eyes become yellow.

When the bile duct is blocked, a biliary drain helps bile flow from the liver into the intestine. Depending on the type of biliary tube, it may be connected to a drainage bag outside the body.

What causes blockage of the bile ducts?

The condition in which bile becomes congested is called cholestasis. Several diseases can cause cholestasis, including:

• Hepatitis (inflammation of the liver).
• Cirrhosis (a slowly developing disease in which healthy liver tissue is replaced with scar tissue).
• Primary biliary cholangitis (a liver disease caused by destruction of the bile ducts in the liver).
• Gallstones.
• Tumors in parts of the digestive system, including the pancreas, gallbladder, or liver.
• Infection.

Certain medications can also cause cholestasis, including certain antibiotics, etc.

What are the symptoms of cholestasis (blockage of the bile ducts)?

The symptoms of cholestasis include:

• Jaundice.
• Itching all over the body.
• Dark urine.
• Pale stools.

What happens during biliary drainage?

During a biliary drainage procedure, a catheter (a thin, hollow tube) is inserted into the liver through the skin. Depending on the type of procedure, the tube may be connected to a plastic bag outside the body. The bag collects the bile that is drained from the liver.

How is a biliary drainage procedure performed?

These are the steps in performing a biliary drainage procedure:

• The patient’s abdomen is cleaned with antiseptic and the skin is numbed with a local anesthetic.
• The doctor inserts a thin needle into the patient’s skin and into a bile duct in the liver.
• The doctor injects a contrast medium (dye) so that the bile ducts and liver can be seen on x-ray.
• The biliary drain is then inserted into the bile duct to allow it to drain.
• The other end of the biliary tube/drain is connected to a bag on the outside of the patient’s abdomen. The bile from the drain will go into the bag. The bag must be emptied several times a day.

What are the risks of a biliary drainage procedure?

The main risks of a biliary drainage procedure are bleeding, infection, or puncturing of the gallbladder or intestine, which would cause bile to leak into the abdomen.

What happens after a biliary drainage procedure?

A biliary drainage procedure is usually an outpatient procedure, which means the patient goes home the same day. Patients are usually observed in the hospital for several hours to make sure there are no unusual side effects from the procedure before they go home.

You cannot drive right after the tube is placed because of the medications you received during your procedure. A responsible adult must drive you home when you are discharged. You may drive the day after your procedure, unless your doctor tells you not to.

Here are some other things to take note of after a biliary drainage procedure:

• You may go back to your normal diet after the procedure.
• You should replace the fluids that are lost through your drainage bag by drinking equal amounts of electrolyte-enriched sports drinks, such as Gatorade®. Drink at least six to eight glasses of fluid a day while your tube is in place. Your doctor may have other recommendations on how you should replace your fluids.
• Get plenty of rest after the procedure. A responsible adult should stay with you the first night after your procedure.
• Avoid lying or sleeping on the same side as the tube to keep it from twisting.
• You may go back to your normal activities 24 hours after your procedure.
• Do not lift anything heavier than 10 pounds, unless you are told otherwise.
• Keep taking all of your prescribed medicines after the procedure unless your doctor tells you otherwise.
• You may shower 48 hours after your procedure, but DO NOT swim or soak in water while tube is in place. Take your dressing off before entering the shower.

When should I call a doctor after a biliary drainage procedure?

Watch for the following signs and symptoms after a biliary drainage procedure:

• Redness, drainage, foul odor, or swelling on the skin around the tube site.
• Pain in the abdomen.
• Nausea or vomiting.
• A change in the color of your stool to a very light or grayish white.
• Shaking chills.
• Temperature above 100.4°F or 38°C.
• A yellowing of the skin and eyes.
• Very dark urine.

If you have any of these signs or symptoms, follow these steps:

• If the tube is capped, uncap it and attach it to a drainage bag. Be sure the drainage bag is below the level of the tube site.
• If your tube is already attached to a drainage bag, remove your dressing and check to see if the tube is twisted.
• If the tube is twisted, straighten it until fluid begins to flow.
• If fluid does not drain after removing the twist in the tube, you may need to gently flush the tube.

If these steps do not relieve the signs and symptoms, call your doctor or go to the nearest emergency department.