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Often diagnosed by HIDA scan, a bile leak from an accessory bile duct post-op can be treated with a temporary biliary stent [citation needed] to redirect the bile from the liver into the intestine and allow the accessory duct to spontaneously seal itself or using a drainage guided by radiology. [11]
Biliary drainage is performed with a tube or catheter (called a biliary drain, biliary stent or biliary catheter) by a surgeon or, commonly, an interventional radiologist. [3] It can be used to relieve a blockage in the bile duct, either permanently or as a temporary solution before definite treatment such as surgery.
Hypaque or other water-soluble dye may be placed through the passage to ensure patency of the stent on fluoroscopy. [15] Enteric and colonic SEMS are inserted in a similar fashion, but in the duodenum and colon respectively. [16] Biliary SEMS are used to palliatively treat tumours of the pancreas or bile duct that obstruct the common bile duct.
In cases of malignant biliary obstruction, endoscopic stent placement is one of the treatment options to relieve the obstruction. Biliary drainage is considered effective, particularly in bile duct conditions that are diagnosed and treated early. [12]
A catheter and guidewire is moved up into the common bile duct. A sphincterotome can then enlarge the ampulla of Vater and release the stones. [106] Later, the endoscopist can place a stent in the common bile duct to soften any remaining stones and allow for bile drainage. If needed, a balloon catheter is available to remove any leftover stones ...
It may also be used in patients with a cystic duct occlusion, or a pre-existing uncovered metal biliary stent. Some advantages include a high success rate with few complications and a reduced need for reinterventions. The primary drawback is the risk of stent occlusion with food or gastric contents.
Other procedures associated with ERCP include the trawling of the common bile duct with a basket or balloon to remove gallstones and the insertion of a plastic stent to assist the drainage of bile. [11] Also, the pancreatic duct can be cannulated and stents be inserted. The pancreatic duct requires visualisation in cases of pancreatitis.
The purpose of biliary endoscopic sphincterotomy in the treatment of a bile leak is to reduce or eliminate the pressure gradient between the bile duct and the duodenum, encouraging transpapillary bile flow and allowing the leak to heal. [7] Others: Palliation of malignant biliary strictures; Gallbladder drainage; Biliary parasite removal; Sump ...