What is a biliary drain?

A biliary drain is a thin, flexible tube with several small holes along the sides. Healthcare providers use biliary drains when bile (a fluid that helps with digestion) can’t drain well from the bile duct that connects your liver to your small intestine.

If something is blocking this duct, bile can back up into your liver (cholestasis). This can cause jaundice, which can give your skin and the white of your eyes a yellow hue. It can cause widespread itchiness as well.

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When there’s a bile duct blockage, a biliary drain helps bile flow from your liver into your small intestine. Depending on the type of biliary tube, it may drain to a bag outside your body.

Types of biliary drainage

There are two main types of biliary drainage:

Percutaneous transhepatic biliary drainage (PTBD)

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This type of drainage goes through your skin (percutaneous) in your abdomen, through your liver to your bile duct and then into your duodenum (beginning of your small intestine). The bile then drains through a tube (catheter) and into a bag outside your body and also into your intestine.

Providers use an imaging procedure called fluoroscopy to see the blocked duct and place the catheter.

Endoscopic biliary drainage (EBD)

During an EBD procedure, a provider uses an endoscope (a medical device with a light on the end) and inserts it into your mouth and down your digestive tract until it reaches your bile duct. They then insert a catheter into the scope and into your blocked bile duct to drain it.

Providers may use ultrasound guidance (endoscopic ultrasound-guided biliary drainage), or they may do it with endoscopic retrograde cholangiopancreatography (ERCP).

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The bile drainage can exit your body through a tube out of your nose (endoscopic nasobiliary drainage, or ENBD). Or it can involve internal drainage. With internal drainage, your provider places a stent placed via an endoscope that helps drainage of bile from the liver to the intestine.

Biliary stenting

Depending on the cause of the blockage, your provider may place a permanent stent across the site of the bile duct blockage. They may do this a couple of days after the initial drainage procedure.

Why would I need a biliary drain?

The most common reason for needing a biliary drain is a blockage or narrowing (stricture) of a bile duct. This leads to cholestasis, which is the slowing or stalling of bile flow from your liver.

Several conditions can cause a bile duct blockage and cholestasis, including:

• Pancreatitis (inflammation of your pancreas).
• Pancreatic cancer.
• Cholangiocarcinoma (bile duct cancer).
• Gallbladder cancer.
• Liver cancer.
• Enlarged lymph nodes near your pancreas or liver (typically from cancer).
• Primary sclerosing cholangitis (chronic inflammation in your bile ducts that causes scarring).
• Gallstones in your gallbladder or within a bile duct (choledocholithiasis).
• Certain parasitic infections, like Ascaris lumbricoides, Clonorchis sinensis (Chinese liver fluke) and Fasciola hepatica.
• Injury to bile ducts during surgery.

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