A percutaneous biliary drainage procedure involves the placement of a fine needle through your skin and into your liver. Some numbing medicine will be injected in the skin before the needle is inserted. Intravenous medications may also be given to you to make you more comfortable and relaxed. This is known as conscious sedation.

Following insertion, the needle will be guided to the correct location by an x-ray camera or ultrasound machine. The position of the needle will then be confirmed by the injection of x-ray contrast material (x-ray dye) and/or removal of fluid. X-ray pictures of your liver will then be taken. It may be necessary to make more than one pass of the needle in order to enter the bile duct. Depending on your condition, a drainage tube may be placed, a tissue sample taken, a stone removed, or a blockage of the bile ducts opened with a balloon catheter or stent placement.

If a drainage tube is placed, it will be inserted through the skin and secured in location. It may need to stay in place for a long time to allow your bile fluid to drain. Tubes in the bile system often become plugged after time, which may result in the need to replace the tube at a future date.

If not replaced, a plugged tube may result in a serious infection. If an area of blockage is discovered, an attempt to open the blockage may be performed with a balloon catheter. This involves the insertion of a special tube, which has a tiny deflated balloon. The balloon is positioned at the site of the blockage and is then inflated.

Following this procedure, if there still is not enough bile flow through the area of blockage, a metal mesh tube (stent) may be placed at the site. The stent will widen the duct and improve the bile flow. If a tissue sample is to be taken or a stone removed, either of these procedures can be performed through the needle access already created in your bile system.

Risks associated with the procedure include:

• Pain or discomfort
• Bleeding at the site
• Internal bleeding
• Injury to a blood vessel
• Organ puncture
• Infection of the blood stream

And because a needle is being placed into your bile system, there is also  the risk of:

• Developing a bile leak that may cause peritonitis (an infection of the lining of the abdomen)
• Cholangitis (an infection of the bile fluid)

The development of any infection, including peritonitis or cholangitis, may result in the need for intravenous antibiotics. Risks associated with the x-ray contrast material include an allergic reaction and reduced kidney function.

The medications used for the conscious sedation are associated with the risks of aspiration (inhaling food or liquid into your lungs) or respiratory depression. They may also be other unpredictable risks in this procedure, such as death.

Other procedures can be performed to further evaluate or manage your liver and/or bile duct condition. Please discuss other alternatives with your physician if you are unsure about having this procedure.