As guidance methods for biliary interventions are used US, X-ray, EUS and ERCP. The Bbenefit for US is: availability, repeatability, daily visit of drainage, fast, permanent view, examination before / during / after the procedure, low cost, combination with X-ray, Interventionist is the curing doctor, no delegation, no loss of information. - Handicaps are: air, bones, low experience, suboptimal possibility of demonstration. ñ A precondition for intervention is visibility!
Methods of Drainage of biliary system are: 1. drainage of biliary duct system (extern; extern-intern (for dilatation, cholangioscopy, stone therapy); intern; rendezvous-method (PTCD+ERCP); 2. drainage of gallbladder; 3. drainage of biliary leakage/bilioma/biliary abscess.
Indications for biliary drainage are: stenosis by tumour, stenosis by stone, stenosis postoperative.
Biliary drainages are made temporary, pre-OP, long-time, palliative.
Special problems & complications are: leakage, bleeding, cholangitis, catheter obstruction, bile acid loss. The use of CEUS to control drainage is an alternative option to control. - Cholecystostomy is an indication in acalculous cholecystitis and in palliative situation. ñ The INVUS guidelines gave recommendation for the biliary interventions.