What are Hepatobiliary Interventions?
Hepatobiliary interventions encompass a spectrum of minimally invasive, image-guided procedures targeting the liver (hepato-), bile ducts, and gallbladder (biliary system). These conditions may arise from gallstones, tumours, strictures, infections, or post-surgical complications that obstruct the normal flow of bile, leading to jaundice, infection (cholangitis), or liver damage. Rather than requiring major open abdominal surgery, an interventional radiologist can access these structures percutaneously through a small puncture in the skin under real-time ultrasound and fluoroscopic guidance.
Common hepatobiliary procedures include Percutaneous Transhepatic Biliary Drainage (PTBD), biliary stenting, liver abscess drainage, cholecystostomy (gallbladder drainage), and Transjugular Intrahepatic Portosystemic Shunt (TIPSS) for portal hypertension. Each procedure is tailored to the patient's specific diagnosis, anatomy, and clinical condition, often offering a safer and faster route to recovery than traditional surgery.
Who Needs Hepatobiliary Interventions?
These procedures are considered for patients with obstructive jaundice caused by gallstones, bile duct strictures, or malignant tumours of the pancreas, liver, or bile ducts that block normal bile drainage. They are also indicated for patients with cholangitis a serious bacterial infection of the bile ducts requiring urgent biliary decompression. Liver abscesses (pyogenic or amoebic) that fail to respond to antibiotics alone are drained percutaneously under imaging guidance. Patients with acute cholecystitis who are unfit for surgery can have their gallbladder drained via cholecystostomy. Those with complications of portal hypertension such as refractory variceal bleeding or refractory ascites may benefit from a TIPSS procedure. Additionally, post-operative biliary leaks or anastomotic strictures following liver transplantation or hepatobiliary surgery are frequently managed with percutaneous or endoscopic–radiological combined techniques.
How are These Procedures Performed?
- Imaging Guidance: All hepatobiliary interventions are performed under real-time ultrasound and/or fluoroscopy (X-ray) to precisely target bile ducts, the gallbladder, or liver collections, minimising risk to surrounding structures.
- PTBD (Percutaneous Transhepatic Biliary Drainage): Under local anaesthesia and sedation, a fine needle is advanced through the skin and liver parenchyma into a dilated bile duct. A guidewire is passed and a drainage catheter is positioned to relieve biliary obstruction, draining bile either externally or into the bowel.
- Biliary Stenting: Once the bile duct is accessed, a self-expanding metal or plastic stent can be deployed across a stricture or tumour to re-establish permanent internal bile flow, often avoiding the need for an ongoing external drain.
- Liver Abscess Drainage: Using ultrasound guidance, a drainage catheter is placed directly into a liver abscess cavity, evacuating infected material and allowing irrigation with antibiotics until the collection resolves.
- Cholecystostomy: In critically ill patients with acute cholecystitis, a small drain is inserted into the gallbladder under imaging guidance to decompress it and treat infection, bridging to definitive surgery or providing definitive palliation.
- TIPSS: A stent is placed between the hepatic vein and portal vein via the jugular approach to reduce portal pressure, effectively treating complications of liver cirrhosis such as variceal bleeding and refractory ascites.
