Treatment of Biliary Tract Diseases

The treatment of biliary tract diseases is planned with a multidisciplinary approach. The main goal is to restore bile flow, reduce the risk of complications, and preserve liver function.

The biliary tract is a complex system of thin channels that carry bile from the liver to the small intestine. Healthy function of these ducts is critical for digestion and liver health. Diseases affecting the biliary tract may include obstructions, inflammation, strictures, and tumors, which can disrupt bile flow and cause jaundice, abdominal pain, itching, and infections.

What Are Biliary Tract Diseases?

Biliary tract diseases are mainly classified into two categories: benign and malignant. Benign conditions include bile duct obstructions due to stones, inflammatory strictures, primary biliary cholangitis, and sclerosing cholangitis. Malignant diseases include bile duct cancers, pancreatic head cancer, and tumors that spread from nearby organs. These conditions can lead to narrowing or blockage of the bile ducts and impairment of liver function.

Primary Treatment Methods for Biliary Tract Diseases

Medical Therapy

Treatment may include antibiotics, choleretic drugs that increase bile flow, and analgesics to suppress infection and relieve symptoms.

Endoscopic Procedures

Endoscopic stone removal, dilation of strictures, or stent placement are often the first-choice interventions for obstructions. ERCP (Endoscopic Retrograde Cholangiopancreatography) uses a side-viewing duodenoscope guided through the esophagus-stomach-duodenum and fluoroscopy to visualize and treat bile and pancreatic ducts.

Surgical Interventions

Laparoscopic or open surgeries (e.g., gallbladder removal, bile duct reconstruction) can permanently resolve anatomical problems and may be necessary in complex lesions.

Liver Transplantation

In advanced stages of irreversible liver failure caused by biliary diseases, liver transplantation may be considered a life-saving option.

Interventional Radiology

Using ultrasound or fluoroscopy, minimally invasive procedures like percutaneous drainage, balloon dilation, or metal stent placement are performed through the skin with needles or catheters. These methods are used when endoscopic access is not feasible or surgery is risky, helping to restore bile flow and reduce jaundice or infection.

Interventional Radiology in Benign Biliary Obstructions

When ERCP is unsuccessful or anatomically not possible, interventional radiology becomes a key alternative. Through Percutaneous Transhepatic Cholangiography (PTC), access to the bile ducts is achieved through the abdominal skin, enabling drainage catheter or stent placement. This minimally invasive method improves quality of life and serves as a surgical alternative—especially in high-risk patients.

The Role of Interventional Radiology in Malignant Biliary Obstruction

Cancers of the liver, pancreas, stomach, or duodenum—or metastases compressing the bile ducts—can block bile flow, causing it to accumulate in the liver and enter the bloodstream, resulting in jaundice. Jaundice can interrupt cancer treatment, especially when bilirubin levels rise beyond safe thresholds for chemotherapy.

Surgical options are often not feasible due to comorbidities. Gastroenterologists may attempt drainage via ERCP through the mouth. Alternatively, interventional radiology offers percutaneous techniques—accessing the bile ducts directly through the liver and using guidewires, catheters, or stents to relieve the obstruction and lower bilirubin levels, enabling continuation of chemotherapy.

What Happens Before and After Treatment of Biliary Obstruction?

Before treatment, a thorough assessment of the patient’s general condition, liver function, and signs of infection is essential. Procedures are performed under sterile conditions with local anesthesia, guided by imaging tools such as ultrasound and fluoroscopy. Post-procedure care includes monitoring drainage catheters, preventing infections, and ensuring stents remain open. Any signs of bleeding, infection, or blockage are closely monitored. A multidisciplinary approach is essential throughout the treatment process.