Ep. 628 Techniques for Managing Biliary Drain Complications with Dr. Ahsun Riaz

Patients and IRs alike dread the persistent cycles of malfunction and repeated procedures that often accompany biliary drains. What can you do to keep patients off the doorstep of reintervention? In this episode of the BackTable Podcast, Dr. Ahsun Riaz of Northwestern Medicine joins host Dr. Michael Barraza to walk through strategies for preventing and managing complications of percutaneous biliary drain placement. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:51 - Complication Rates and Associated Factors06:09 - PTC in Non-Dilated Biliary Systems11:00 - Techniques for Access and Drain Placement15:10 - Drain Flushing, Capping, and Ideal Positioning17:48 - External versus Internal-External Biliary Drains20:42 - Managing Pericatheter Leakage23:01 - Life Expectancy and Stenting Malignant Strictures26:32 - Tract Maturation and Minimizing Access Sites28:56 - Addressing Unresolving Hyperbilirubinemia34:52 - Managing Bloody Drain Output38:12 - Approach to Dislodged Drains39:40 - Drain-Associated Pain and Exchange Timing42:49 - Strategy for Benign Biliary Strictures45:18 - Final Thoughts and Closing Remarks --- More about this episode The discussion begins with a look at the data on biliary drain-related adverse events, emphasizing the need to bring down the high rates of complications that may take a toll on patients' quality of life. Dr. Riaz stresses the importance of employing techniques at initial drain placement, such as placing left-sided drains where appropriate and minimizing biliary pressure buildup, to reduce the starting risk of malfunction. The physicians go on to share their algorithms for approaching various scenarios, from pericatheter leakage and drain dislodgement to unresolving hyperbilirubinemia, pointing out the factors and observations that should influence treatment approaches during planning and intraprocedurally. Finally, the physicians address the evolving landscape of long-term biliary management, assessing potential drainage strategies as survival rates improve in hepatobiliary malignancies, and underscore the critical importance of collaboration with gastroenterologists and surgeons to ensure cohesive, goals-of-care-centered management. --- Resources Adverse Events After Percutaneous Transhepatic Biliary Drainage: A 10-Year Retrospective Analysishttps://doi.org/10.1016/j.jvir.2024.12.022