Radiologic Interventions in Biliary Pathologies: An Overview

Percutaneous biliary interventions, including percutaneous transhepatic biliary drainage (PTBD) and cholecystostomy, serve as indispensable therapeutic modalities for complex benign and malignant biliary pathologies. Although endoscopic techniques are the primary approach for distal obstructions, interventional radiology is essential for managing hilar lesions, altered postsurgical anatomy, such as that following living-donor liver transplantation (LDLT), and cases in which endoscopic approaches have failed. This review outlines the indications, preprocedural steps, and techniques of percutaneous biliary procedures, emphasizing the shift from temporary external drainage to more effective palliative techniques, such as stenting. The procedural techniques and strategies discussed include evaluating right- versus left-sided approaches, stricture navigation, and management of major complications such as hemorrhage. The therapeutic endpoints for malignant and benign obstructions are highlighted, such as the deployment of self-expandable metallic stents (SEMS) for palliative management versus balloon cholangioplasty and tissue remodeling for benign strictures. The article also discusses several therapies performed through the PTBD route, including endobiliary radiofrequency ablation, intraluminal brachytherapy, photodynamic therapy, and post-transplant recanalization techniques like magnetic compression anastomosis and biodegradable stenting. Meticulous patient selection and a thorough technical understanding of these radiological interventions are necessary to successfully restore physiological bile flow, treat and manage impending sepsis, and significantly improve patients' quality of life.