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Percutaneous Biliary Interventions - Advancements and Applications

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Percutaneous biliary interventions comprise different procedures for diagnosing and treating different types of biliary disease.

Written by

Dr. Ruchika Raj

Medically reviewed by

Dr. Vasavada Bhavin Bhupendra

Published At January 10, 2024
Reviewed AtJanuary 10, 2024


Percutaneous biliary interventions encompass a range of procedures that involve the percutaneous access of the biliary system (comprising the liver, bile duct, and gallbladder). These interventions have become an integral part of hepatobiliary medicine, providing minimally invasive alternatives to traditional surgical approaches. By utilizing imaging guidance and specialized tools, interventional radiologists and hepatobiliary surgeons (doctors specializing in liver and bladder surgeries) can diagnose and treat various biliary disorders with reduced morbidity and quicker recovery times.

What Are Different Types of Percutaneous Biliary Interventions?

Different types of percutaneous biliary interventions used in the medical field are:

  1. Percutaneous Transhepatic Cholangiography (PTC): PTC involves the percutaneous insertion of a catheter (thin tube) into the biliary system under radiological guidance to visualize and assess biliary obstructions or abnormalities. It serves as a diagnostic tool and a prelude to therapeutic interventions.

  2. Percutaneous Transhepatic Biliary Drainage (PTBD): Percutaneous transhepatic biliary drainage is commonly employed to relieve biliary obstruction by placing a drainage catheter (thin tube used to drain the excess fluid). This intervention is mostly used in cases of severe infection like large liver abscesses or cysts (fluid-filled sacs in the liver). It offers symptomatic relief and can serve as a bridge to surgery or other definitive treatments.

  3. Percutaneous Biliary Stenting (PBS): Percutaneous biliary stenting (placing an artificial stent in the bile duct) is a vital component of percutaneous biliary interventions, as it helps maintain biliary patency (maintain patency or opening of the bile duct to prevent any blockage). Covered or uncovered stents are used depending on the underlying condition. Biliary stents are available in different sizes, shapes (angled, wedged, winged, and curved), and materials (Teflon, polyurethane, and plastic). This procedure is usually performed in cases of obstructive jaundice.

What Are Different Applications of Percutaneous Biliary Interventions?

Different applications or uses of percutaneous biliary interventions in the realm of biliary medicine are:

  • Biliary Obstruction: These procedures are essential for the relief of biliary obstruction caused by conditions like choledocholithiasis (presence of stone in the bile duct), malignancies, or postoperative strictures.

  • Biliary Leak Management: Percutaneous interventions can effectively treat postoperative bile leaks (leakage of bile from the bile duct due to injury to the duct during surgery) and other traumatic biliary injuries.

  • Complications of Endoscopic Retrograde Cholangiopancreatography (ERCP): Endoscopic retrograde cholangiopancreatography is a surgical method for diagnosing the presence of gallstones or bile stones, tumors, and other obstructions using an endoscope (a thin tube-like catheter attached with tiny camera used to see images of inner body organs clearly). In cases of endoscopic retrograde cholangiopancreatography-related complications, such as perforations or failed cannulation, percutaneous interventions can provide solutions to manage such clinical situations.

  • Palliative Care: For patients with inoperable malignant biliary obstructions (bile duct obstruction due to cancerous lesions), percutaneous biliary stenting can offer palliative relief.

What Are Newer Advancements in Percutaneous Biliary Interventions?

Various current advancements that have enlightened the diagnostic field of hepatobiliary medicine are:

  • Image-Guided Precision: The integration of advanced imaging techniques, such as fluoroscopy, ultrasound, and CT (computed tomography) guidance, has greatly improved the accuracy and safety of percutaneous biliary procedures.

  • Minimally Invasive Techniques: Smaller caliber catheters and instruments have made these interventions less invasive, reducing patient discomfort and recovery time.

  • Stent Technology: Stent advancements include the development of drug-eluting stents, which can help combat issues like stent-related infections and recurrent strictures.

  • Endoscopic-Retrograde Cholangiopancreatography (ERCP) Rescue: In cases where ERCP fails, percutaneous biliary interventions offer a viable rescue option to address biliary (liver and bile duct-related) complications.

What Are the Complications Associated With Percutaneous Biliary Interventions?

Complications associated with percutaneous biliary interventions can vary depending on the specific technique, patient factors, and underlying liver diseases. It is crucial to be aware of these potential complications and strategies to mitigate risks. Some common complications and ways to cope with them are:

  • Bleeding: Proper patient selection and pre-procedure coagulation assessment (bleeding risk assessment) are essential. Additionally, the use of meticulous techniques, including the use of smaller caliber needles, can reduce the risk of bleeding.

  • Infection: Maintaining strict sterile techniques during the procedure and ensuring aseptic precautions can significantly reduce the risk of infection. Prophylactic antibiotics may be considered in certain high-risk cases.

  • Pain and Discomfort: Adequate local anesthesia is crucial to minimize patient discomfort during the procedure. The use of conscious sedation can also help in managing pain and anxiety.

  • Biliary Perforation: Careful needle placement and guidance under imaging can help avoid unintentional punctures. In the case of perforation, prompt recognition and the ability to perform additional interventions, such as stent placement, can mitigate this complication.

  • Stent-Related Complications: Choosing the appropriate stent type, size, and placement location is crucial. Regular follow-up and surveillance are essential to detect and address any stent-related issues quickly.

  • Post-procedural Inflammation: Adequate post-procedural care and monitoring are necessary to address inflammatory responses. This might include the use of anti-inflammatory medications and follow-up imaging.

  • Procedure-Specific Complications: Ensuring proper technique and using the right drainage catheter can help minimize complications specific to the procedure. In cases of bile leakage, prompt recognition and possible stent placement can manage the issue.

  • Allergic Reactions: Prior to the procedure, assess the patient's allergies and sensitivities. Avoid allergenic substances in radioactive contrast agents or medications when possible.

  • Radiation Exposure: Radiologic procedures involve exposure to ionizing radiation. Using appropriate shielding and minimizing fluoroscopy time can reduce radiation exposure. It is also essential to follow ALARA (As Low As Reasonably Achievable) principles, which state the use of minimal radiations as much as possible.

  • Delayed Complications: Some complications, such as late stent occlusion, can occur after the procedure. Regular follow-up, imaging, and patient education on recognizing signs of complications are crucial for early intervention.

  • Patient Education: Providing patients with clear instructions for post-procedure care and recognizing signs of complications can empower them to seek medical attention promptly if issues arise.


Percutaneous biliary interventions have evolved into essential tools for managing a wide range of hepatobiliary conditions. Advancements in technology and techniques have made these procedures safer and more effective, offering patients minimally invasive alternatives to traditional surgical approaches. As the field continues to progress, percutaneous biliary interventions are likely to play an increasingly pivotal role in the treatment of biliary disorders, enhancing patient outcomes and quality of life.

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Dr. Vasavada Bhavin Bhupendra
Dr. Vasavada Bhavin Bhupendra

Surgical Gastroenterology


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