Biliary drainage and stenting
A keyhole, image-guided procedure that drains bile from a blocked bile duct, by placing a thin tube through the skin into the liver and often a stent to hold the duct open, used to relieve jaundice and itching.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Biliary drainage relieves a blocked bile duct by draining bile through a thin tube placed in the liver, easing jaundice and itching.
- A stent is often placed across the blockage so bile can drain internally again.
- It is placed through a small skin puncture under local anaesthetic and sedation, not a surgical cut, and antibiotics are given.
- It relieves the blockage but does not cure its cause (often a cancer or gallstones), which still needs separate treatment.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your radiologist will give you advice for your situation.
Relieves a blocked bile duct so bile can drain again
A bleeding tendency or blood-thinning that cannot be safely corrected before a liver puncture.
You are relaxed with sedation and pain relief. The puncture site is numbed; you may feel pushing or pressure as the tube is placed.
Clear teaching on caring for the tube and bag before you go home, with spares and a contact number.
You are relaxed with sedation and pain relief. The puncture site is numbed; you may feel pushing or pressure as...
You lie flat in bed while staff monitor your pulse, blood pressure and the tube, and watch for bleeding or...
Jaundice and itching usually start to ease as bile drains. You learn to care for the tube and bag if one is left...
If an external tube was left, you may return to have the blockage crossed and a stent placed, sometimes allowing...
What is biliary drainage and stenting?
Bile is a fluid made by the liver that flows through narrow tubes (the bile ducts) into the bowel to help digest food. If a bile duct becomes blocked, bile cannot escape and backs up into the blood, turning the skin and eyes yellow (jaundice) and often causing severe itching. Biliary drainage relieves this. An interventional radiologist passes a fine needle through the skin into the liver, finds a bile duct using X-rays and dye, and places a thin tube to drain the bile.
The first step is usually a picture of the bile ducts, called a percutaneous transhepatic cholangiogram (PTC), to show where the blockage is. A drainage tube is then placed. It may drain into a bag outside the body, drain both internally and externally, or, once the blockage is crossed, allow a stent (a short tube of metal or plastic) to be left across the narrowing to hold it open so bile flows internally again.
There is no large surgical cut, only a small puncture in the skin, numbed with local anaesthetic and usually with sedation. Antibiotics are given because infection is often present in a blocked duct. The blockage is frequently caused by a cancer (of the pancreas, bile duct or nearby) or by gallstones, and this procedure is often done urgently, especially if the blocked bile is infected. It relieves the blockage but does not by itself cure the cause, which still needs its own treatment.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
PTC (cholangiogram)
X-ray pictures of the bile ducts, taken using dye through a fine needle, to show where and why the duct is blocked before draining it.
External biliary drain
A tube that drains bile out of the body into a bag. Used when the blockage cannot yet be crossed, or to settle infection first.
Internal-external drain
A tube that passes through the blockage so bile can drain both into the bowel and, if needed, into a bag, giving more flexibility.
Biliary stent
A short metal or plastic tube left across the narrowing to hold it open so bile drains internally; the external tube can often then be removed.
Preparing for your procedure
- In an emergency there may be little time; the team will explain what they can and may take consent quickly while treating you.
- Tell the team about allergies, especially to contrast dye, and about asthma.
- Blood tests check your clotting and liver function, as a blocked liver can affect clotting.
- List all your medicines, especially blood thinners, as these usually need pausing for a liver puncture.
- You will usually be asked not to eat for a few hours beforehand; follow the team's advice on drinks.
- A drip is placed for fluids and antibiotics, which are given before the procedure because infection is often present.
- Tell the team if you are or might be pregnant, as the procedure uses X-rays.
What happens
You lie on the X-ray table and the skin over the right side of your tummy or lower chest is cleaned and numbed with local anaesthetic. You are usually given sedation and pain relief, and antibiotics through the drip. Using X-ray pictures, the radiologist passes a fine needle through the skin into a bile duct in the liver and injects dye to show where the blockage is.
A guidewire is passed and the drainage tube is threaded over it into the bile duct. If the blockage can be crossed, the tube can be passed through it, and a stent may be placed across the narrowing to hold it open. Whether bile drains internally, externally into a bag, or both depends on what is found.
The tube is fixed to the skin and connected to a bag if needed. You lie flat in bed for several hours afterwards while staff monitor your pulse, blood pressure and the tube. Most people stay in hospital at least overnight, and longer if they are unwell with infection. Jaundice and itching usually ease over the following days.
Is this procedure right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- A bleeding tendency or blood-thinning that cannot be safely corrected before a liver puncture.
- When the blockage can be relieved more safely from inside by ERCP (a telescope via the mouth).
- Widespread or end-stage disease where the burden of a drain may outweigh the benefit, which needs careful discussion.
- A severe, unmanaged contrast dye allergy where the procedure is not essential.
Delay or rearrange if…
- Clotting is severely deranged and can be corrected first (in non-urgent cases).
- Blood thinners have not been adjusted and the situation is not an emergency.
- You might be pregnant, as the procedure uses X-rays (balanced against the urgency).
- Note: if the blocked bile is infected, drainage is usually urgent and should not be delayed.
Alternatives to discuss
- ERCP, reaching the bile duct from inside with a flexible telescope, often tried first where suitable.
- Surgery to relieve the blockage or treat the cause in selected patients.
- Treating the underlying cause directly, such as removing gallstones.
- Best supportive care focused on symptoms if active drainage is not appropriate, after careful discussion.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Relieves a blocked bile duct so bile can drain again
- Eases jaundice and the severe itching it causes
- Allows infection in a blocked duct (cholangitis) to be treated
- A stent can restore internal bile flow so no external bag is needed
- Can be done urgently when someone is unwell, and avoids a major operation
- Buys time and can prepare you for treatment of the underlying cause
Risks & complications
- Some bruising or soreness at the tube site
- A small amount of bile leaking around the tube
- Aching in the right side of the tummy for a few days
- Getting used to caring for the tube and bag if an external drain is left
- Infection of the bile or bloodstream (cholangitis or sepsis), which can make you unwell
- Bleeding around or into the liver, or blood in the bile
- The tube blocking, leaking or moving, needing it to be adjusted or replaced
- A mild allergic reaction to the dye
- Heavy bleeding needing a transfusion or a further procedure (such as embolisation) to stop it
- Severe infection (sepsis) making you very unwell
- A bile leak into the tummy, or injury to nearby structures such as the bowel or lung lining
- Rarely, the radiologist cannot place the drain and another approach is needed
The two biggest concerns are infection and bleeding. A blocked bile duct is often already infected, so antibiotics are given and sepsis is watched for closely; some UK patient information puts the risk of a bloodstream infection and of significant bleeding at under about 1 in 20 each. Ask your team how likely it is the blockage can be crossed and stented in one go, what the plan is to treat the underlying cause, and what to watch for at home.
Published figures to discuss
Risk depends on how unwell you are, whether the bile is infected, your clotting and the cause of the blockage. Infection and bleeding are the main concerns. The figures below are cautious and drawn from UK patient information; your own risk may differ, and serious complications are uncommon.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Bloodstream infection | Some UK patient information quotes under about 1 in 20 (less than 5%) | A blocked duct is often already infected, so antibiotics are given and sepsis is watched for. | Complications of PTC and biliary drainage (multicentre study) - PMCncbi.nlm.nih.govPublished figure |
| Bleeding around or into the liver | Some UK patient information quotes under about 1 in 20 (less than 5%) | Usually minor; heavy bleeding rarely needs a transfusion or embolisation to stop it. | Complications of PTC and biliary drainage (multicentre study) - PMCncbi.nlm.nih.govPublished figure |
| Drain or stent blockage or displacement | Common enough to require clear follow-up plans | Recurrent jaundice, fever, bile leak or reduced drain output can mean the tube needs flushing, exchange or another procedure. | Guide sourcesClinical context |
| Failure to relieve jaundice fully | A minority, higher with complex hilar obstruction or advanced cancer | Biliary drainage can improve infection, itch or chemotherapy access, but may not change the underlying cancer. | Complications of PTC and biliary drainage (multicentre study) - PMCncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no large wound, only a small skin puncture, but you may have a tube and bag to manage, and recovery is shaped mainly by the underlying cause and whether infection was present. Most people stay in hospital at least overnight.
- Jaundice and itching gradually easing over the days after drainage
- Some aching at the tube site and in the right side of the tummy
- A little bile leaking around the tube at first
- Getting used to emptying and caring for a drainage bag if one is left
Aftercare
- Keep the tube site clean and dry and follow the advice you are given on dressings.
- If you have an external bag, empty it regularly and keep the tube from kinking or being pulled.
- Watch the colour and amount of bile draining and report a sudden change.
- Take any antibiotics exactly as prescribed and finish the course.
- Watch for fever, shivering or feeling unwell, which can signal infection, and seek help promptly.
- Restart paused medicines, such as blood thinners, only when told to.
- Attend appointments for any planned stent, tube change or treatment of the cause.
- Clear instructions and a demonstration on caring for the tube and bag if one is left
- Spare bags and dressings, and how to get more
- The ward or radiology contact number for fever, blockage, leaking or the tube coming out
- A note of which medicines, especially blood thinners, to stop and restart and when
- The date for any planned stent or tube change
- Support at home if you find managing the tube difficult
⚠ Get urgent help if…
- A high fever, shivering or feeling very unwell (possible serious infection or sepsis)
- Worsening jaundice, or pale stools and dark urine, suggesting bile is not draining
- The tube stops draining, leaks heavily or falls out (cover the site and contact the team urgently)
- Severe or worsening tummy pain
- Bright red blood in or around the tube, or in vomit or stools
- Spreading redness, swelling or discharge at the tube site
- Feeling faint or a racing heart
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your radiologist gives you.
Results & realistic expectations
A good result means bile drains again, and jaundice and itching ease over the following days. If infection was present, you should start to improve as it is treated. A stent placed across the blockage can restore internal bile flow so no external bag is needed.
Biliary drainage relieves the blockage but does not cure its cause. Whatever is blocking the duct, often a cancer or gallstones, still needs its own treatment, which your team will plan. Stents can block or become infected over time, so they may need replacing, and you should know the signs that bile is not draining.
How long a drain or stent keeps working varies. Plastic stents tend to block sooner and are often planned for replacement; metal stents usually stay open longer. Drains and stents can block or become infected, so they may need changing, and your team will tell you what to expect and what signs mean a stent is no longer draining. The bigger picture depends on treating the underlying cause.
Related tests, treatments or support
Biliary drainage is often part of wider treatment. It may be combined with antibiotics for infection, with treatment of the underlying cause (such as surgery, chemotherapy or radiotherapy for a cancer, or removing gallstones), and sometimes with endoscopic treatment (ERCP) as an alternative route. The liver/biliary and cancer teams plan these together.
Follow-up & long-term care
You stay under the liver/biliary team, who treat the cause of the blockage, arrange any planned stent or tube change, and check the drain or stent is working. The tube site, drainage and signs of infection are monitored. Report fever, worsening jaundice, blockage, leaking, bleeding or the tube coming out straight away.
- Stent or tube changes when planned, or if a stent blocks
- Keeping the site clean and any bag draining freely day to day
- Antibiotics if infection develops
- Treatment of the underlying cause, such as a cancer or gallstones
- Regular review of liver function and the drain or stent
Repeat, follow-on and what comes next
- An external tube is often exchanged later for an internal stent once the blockage is crossed.
- Stents can block or become infected and may need replacing, particularly plastic stents.
- A blocked or displaced drain may need adjusting or replacing.
- The underlying cause still needs its own treatment.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear teaching on caring for the tube and bag before you go home, with spares and a contact number.
- Written warning signs for infection, bleeding, blockage and the tube coming out.
- A clear plan for any stent or tube change and for treating the underlying cause.
- Monitoring of liver blood tests to confirm bile is draining.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether it is an emergency or planned procedure
- Whether a stent is placed, and whether it is plastic or metal
- Sedation or general anaesthetic and the level of monitoring needed
- The length of hospital stay, especially if you are unwell with infection
- Stent or tube changes over time
- The interventional radiologist's fee, the facility fee and treatment of the underlying cause
- The interventional radiologist's fee and the facility fee
- Contrast dye, sedation or anaesthetic, the drain, the stent and antibiotics
- The likely length of hospital stay
- The cost and timing of any planned stent or tube change
- Whether treatment of the underlying cause is included or separate
- What is covered if a complication, such as infection or bleeding, needs further care
On the NHS? Biliary drainage and stenting is a core NHS service, often delivered urgently; it is rarely arranged privately because it usually forms part of urgent hospital treatment.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not explaining that drainage relieves the blockage but does not cure the cause.
- Not discussing the alternative of ERCP from inside where that is suitable.
- Not preparing you for possibly having an external bag, at least at first.
- No written warning signs for infection, bleeding, blockage or the tube falling out.
- Not explaining that a stent may need replacing over time.
Marketing red flags
- Describing the procedure as simple or without risks.
- Not mentioning radiation, contrast, infection or bleeding.
- Implying drainage treats the underlying cause rather than just relieving the blockage.
- Not explaining the practicalities of caring for a tube and bag.
Choosing a specialist safely
- Check the radiologist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the radiologist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good radiologist will welcome every one of these.
- What is blocking my bile duct, and how will that cause be treated?
- Is this being done urgently because the bile is infected?
- Will I have an external bag, an internal-external drain, or a stent, and why?
- How likely is it that a stent can be placed in one go, and will it need replacing?
- What is my risk of infection or bleeding from the procedure?
- What should I watch for at home that means bile is not draining or I have an infection?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the radiologist who carries out my procedure, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this procedure not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is biliary drainage done on the NHS?
Is it an emergency?
Will I have a bag outside my body?
Will my jaundice and itching go?
What is the difference between this and ERCP?
Does the stent need replacing?
Find a verified radiologist for biliary drainage and stenting
Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.
No verified consultants list this procedure yet — browse the full directory.
How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Newcastle Hospitals NHS - Percutaneous biliary drainage and stent University Hospitals Plymouth NHS - PTC BSIR - What is interventional radiology? Complications of PTC and biliary drainage (multicentre study) - PMC
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Nephrostomy (kidney drainage) · Embolisation to control bleeding · Image-guided drainage of an abscess or fluid · Image-guided spinal injection · IVC filter insertion