BackTable Vascular & Interventional Ep. 628 Techniques for Managing Biliary Drain Complications with Dr. Ahsun Riaz
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Mar 27, 2026 Dr. Ahsun Riaz, interventional radiologist specializing in percutaneous biliary procedures, shares practical approaches to reduce drain complications. He discusses choosing left versus right access, techniques for non-dilated systems, optimal insertion tools and positioning, strategies for flushing versus capping, and managing dislodgement, leakage, bloody output, and stent decisions.
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Prefer Internal External Drains And Convert Within Two Weeks
- Prefer internal‑external drains whenever possible to avoid dehydration and higher dislodgement with external-only drains.
- If external-only is necessary, plan conversion to internal‑external around two weeks and coordinate GI for combined procedures.
Manage Pericatheter Leakage With Clinic Check And Upsize
- For pericatheter leakage first evaluate clinic flushing; if functioning, observe; if not, upsize the drain (start ≥10F then 12F).
- Early stenting at initial placement reduced leakage in their cohort, even for malignant strictures.
Longer Survival Changes Choice Of Stent For Hilar Disease
- For hilar cholangiocarcinoma longer survival from new systemic therapies changes stent strategy: metal stent patency (~6–8 months) may be inadequate as patients live >12 months.
- Dr. Riaz and society guidance suggest favoring plastic stents for patients expected to need multiple exchanges.