Day #1 PTC with 8 fr or 10 fr PBD Admit
Day #2-3 Biliary tube upsize to 12 fr discharge home if stable
Week #3-4 biliary tube upsize to 14 fr Bentec 1-2 weeks w/possible cholangioplasty
Week # 5-6 biliary tube upsize to 16 fr Bentec 1-2 weeks w/possible cholangioplasty
Week#7-8 biliary tube upsize to 18 fr 1-2 weeks w/possible cholangioplasty
Once the patient has an 18 fr, | bring them back in 3 months for tube change and upsize to 20fr if they have COOK drain . If they have 18 fr Bentec, they will return in 3 months for tube change.
6 months Amplatz anchor trial 1 week
6 months +1 week Whitaker Test
If pass -> tube removal
If fail -> surgical repair or chronic intubation
- Drain to gravity bag x 24 hrs then cap if no fevers, pain or discharge at entrance site
- Patients should be discharged each visit with an extra drainage bag, cap and prescription for 10cc NS flushes
- Each drain should be flushed BID with 10cc NS
- If a patient has a cholangioplasty with a cutting balloon, use a 7 or 8mm cutting balloon
- Any sign of cholangitis, patient should be admitted (transplant for transplant patients or hospitalist for other patients)
- End goal is 18 fr Bentec or 20 fr COOK
- Protocol is designed for 6 months intubation with large tube (18 fr or larger)
Photo by Internet Archive Book Images
Frequently Asked Questions
What is a benign bile duct stricture?
A benign bile duct stricture is a narrowing of the bile duct that is not caused by cancer. It can occur due to inflammation, injury, or surgery. This narrowing can obstruct the flow of bile, leading to symptoms such as jaundice, abdominal pain, and potential infections.
How is a benign bile duct stricture treated?
Treatment for a benign bile duct stricture often involves the placement and gradual upsizing of a biliary tube to dilate the duct. This can include procedures like percutaneous transhepatic cholangiography (PTC) and cholangioplasty, where balloons are used to help open the duct. The goal is to maintain the duct open with increasingly larger tubes over time.
What is cholangioplasty and when is it used?
Cholangioplasty is a procedure used to open up narrowed bile ducts. It often involves inserting a balloon into the duct and inflating it to widen the passage. This is typically done after placing a biliary tube and is used if the stricture does not resolve with tube placement alone.
What is the role of a drainage bag in bile duct stricture treatment?
A drainage bag is used to collect bile that drains from the bile duct through an external tube. It helps prevent bile buildup and infection. Patients are usually discharged with a spare bag and advised on its care to manage bile drainage effectively.
Why is it important to flush the biliary drain regularly?
Regular flushing of the biliary drain with saline (NS) is crucial to prevent blockages and maintain the patency of the tube. It helps to ensure that bile flows freely and reduces the risk of infection or complications.
What happens if a patient shows signs of cholangitis during treatment?
If a patient exhibits signs of cholangitis, such as fever, chills, or abdominal pain, immediate medical attention is required. This condition is an infection of the bile duct and can be serious. Patients may need to be admitted to the hospital for antibiotics and further evaluation.
What is the purpose of the Whitaker test in bile duct treatment?
The Whitaker test is used to assess the pressure within the bile duct system to determine if there is any blockage or abnormality. A successful test, indicating normal pressures, may lead to the removal of the biliary tube. Failure may necessitate surgical repair or continued drainage.
How long does the intubation process typically last for benign bile duct stricture treatment?
The intubation process for treating a benign bile duct stricture is typically designed to last about six months. During this period, the size of the biliary tube is gradually increased to ensure the duct remains open, and the patient is regularly monitored for progress.