Echoguided percutaneous biliary drainage. Indications, performances, complications

Biliary drainage is a well-accepted procedure for decompression of bile ducts or drainage of infected bile. Percutaneous biliary drainage (PBD) can be performed under fluoroscopic, combined fluoroscopic-US or pure US guidance. The indications of PBD are not well established being closely related to the possibility of an endoscopic stenting. Generally, PBD is indicated in malignant obstructive jaundice especially if accompanied by cholangitis. The main contraindications of percutaneous biliary drainage are bleeding disorders, ascites and rupture of an echinococcus cyst. The rate of successful percutaneous US-guided biliary drainage varies between 85-100% being lower in cases with nondilated bile ducts. Acute complications after US-guided PBD (bleeding, septicemia and bile leakage) are rare (1-5%). Delayed complications include catheter occlusion with cholangitis, intrahepatic abscesses, catheter dislodgment with subsequent bile peritonitis, pericatheter leakage and maldigestion. In percutaneous US-guided biliary drainage there are some pitfalls and critical points. Being aware of them and knowing the implied therapeutic approach is very important in the success of procedure and limitation of incidents and complications.