What is duodenal biliary drainage?
Duodenal biliary drainage is a little-used procedure that sometimes can be helpful in diagnosing gallstones. This rare procedure has been out of common use since the late 1940s.
How is duodenal biliary drainage done?
For duodenal biliary drainage, a thin plastic or rubber tube with several holes at its tip is passed through a patient's anesthetized nostril, down the back of the throat, through the esophagus and stomach, and into the duodenum where the bile and pancreatic ducts enter the small intestine. This is accomplished with the help of fluoroscopy, a type of X-ray. Once the tube is in place, a synthetic hormone related to cholecystokinin is injected intravenously. The hormone causes the gallbladder to contract and squeeze out its concentrated bile into the duodenum. The bile then is sucked up through the tube and examined for the presence of cholesterol and pigment particles under a microscope.
A modification of duodenal biliary drainage involves collection of bile through an endoscope at the time of an upper gastrointestinal endoscopy - either by EGD (esophagogastroduodenoscopy) or by ERCP (endoscopic retrograde cholangio-pancreatography).
Why might duodenal biliary drainage be done?
Gallstones begin as microscopic particles of cholesterol or pigment that grow in size. Once the particles grow large enough to become gallstones, they can obstruct the bile ducts and cause problems. It is clear that some people who develop the symptoms and complications of gallstones -- biliary colic, cholecystitis, or pancreatitis - have only these microscopic particles in their gallbladders, particles too small to obstruct the bile ducts.
There are two possible explanations for how obstruction might be occurring in this situation. The first is that a small gallstone obstructed the bile ducts but finally passed through the bile ducts into the intestine. The second is that the particles passing through the bile ducts "irritate" the ducts, causing spasm of the muscle within the walls of the ducts (which obstructs the duct) or causing inflammation of the duct so that the wall of the duct swells (which also obstructs the duct).
What are the risks of duodenal biliary drainage?
The risks to the patient of duodenal biliary drainage are almost nonexistent. There have been no reports of reactions to the synthetic hormone. Nevertheless, the presence of the tube in the throat is uncomfortable for the 30-60 minutes that are necessary to complete the test.
When is duodenal biliary drainage useful?
Once again, it's been decades since duodenal biliary drainage was the medical standard. Still, it can useful in diagnosing problems related to gallstones when other tests such as ultrasonography have not demonstrated gallstones, but suspicion is high that gallstones are the cause of the patient's problem. Cholesterol or pigment particles without gallstones may be present in individuals who have no medical problems or problems that are not due to gallstones. It is unclear whether these individuals ultimately are more likely to develop gallstones. Because such individuals exist, it also is important not to assume that particles mean that gallstones are the cause of a medical problem. The medical problem and its symptoms should be typical of the types of problems caused by gallstones.
Health Solutions From Our Sponsors
"Approach to the patient with incidental gallstones"
Top Duodenal Biliary Drainage Related Articles
Allergy (Allergies)An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
Choledochal CystCholedochal cysts are cysts of the bile ducts. There are several different types of choledochal cysts. These cysts are congenital, however, their cause is not known. Symptoms of choledochal cysts in infants include an enlarged liver and jaundice. In older people, the cysts cause abdominal pain, jaundice, cholangitis, gallstones, and pancreatitis. Treatment for choledochal cysts is surgery.
Cold, Flu, Allergy TreatmentsBefore treating a cold, the flu, or allergies with over-the-counter (OTC) medications, it's important to know what's causing the symptoms, which symptoms one wishes to relieve, and the active ingredients in the OTC product. Taking products that only contain the medications needed for relieving your symptoms prevents ingestion of unnecessary medications and reduces the chances of side effects.
Endoscopy (EGD) Procedure
Endoscopy is a broad term used to described examining the inside of the body using an lighted, flexible instrument called an endoscope. Endoscopy procedure is performed on a patient to examine the esophagus, stomach, and duodenum; and look for causes of symptoms such as abdominal pain, nausea, vomiting, difficulty swallowing, or intestinal bleeding.
ERCP (Endoscopic Retrograde Cholangio-Pancreatography)Endoscopic retrograde cholangio-pancreatography is a procedure that uses a small scope to examine the stomach and intestines. The patient should not eat anything after midnight on the evening preceding the exam. Patients will be giving anesthesia to decrease the gag reflex and medication to cause relaxation and sleepiness. Associated side effects and complications include infection, pancreatitis, bowel perforation, drug reactions, and bleeding.
GallstonesGallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause signs or symptoms; however, when they do occur the primary sign is biliary colic. Symptoms of biliary colic are constant pain for 15 minutes to 4-5 hours, and it may vary in intensity; nausea, severe pain that does not worsen with movement; and pain beneath the sternum. Treatment of gallstones depends upon the patient and the clinical situation.
Acute and Chronic PancreatitisPancreatitis is a rare disease in which the pancreas becomes inflamed. There are two types of pancreatitis: acute and chronic. Symptoms of pancreatitis include abdominal pain, fever, nausea, vomiting, and a rapid pulse. Treatment of pancreatitis often requires hospitalization.
The Digestion Process (Parts, Organs, and Functions)Digestion is the complex process of turning the food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food. Learn more about digestion and the body parts that make it possible, including the mouth, pharynx, esophagus, stomach, small intestine, colon, rectum, anus, pancreas, liver, and gallbladder.