Biliary Drains and Stents During Cancer Care

This page is for people with cancer who have, or may soon have, a biliary stent or drain, and the people caring for them. It explains what these devices do, the emergency warning signs, how they are placed, and how to care for an external bag.

Bile is a liquid the liver makes. It travels down the bile ducts to the gallbladder and small intestine. A biliary stent is a thin, flexible tube that lets bile get past a blockage. A biliary drain is a tube passed through the skin into the liver to carry bile out.

Tumors can block bile ducts. MedlinePlus lists these causes:

• tumors of the bile ducts or pancreas
• enlarged lymph nodes near the liver

Bile then backs up. MedlinePlus lists these signs of a blocked bile duct:

• yellow skin (jaundice)
• dark urine
• clay-colored or pale stools
• itching
• fever
• pain in the upper right belly

Left untreated, a blockage can lead to infection, sepsis and liver disease. An infection of the bile ducts is called cholangitis. MedlinePlus says its outcome is very often good with treatment, but poor without it.

The emergency here is cholangitis. It can lead to sepsis, organ failure and death.

Call 911 or go to the emergency department if:

• Your temperature reaches 100.4 °F (38.0 °C) or higher. CDC uses 100.4 °F and NCI uses 100.5 °F. Use the lower number.
• You get shaking chills, with or without a high reading.
• Pain builds under the right ribs or in the upper belly and will not settle.
• The yellow in your skin or eyes is deepening again.
• You become confused, unusually sleepy, dizzy on standing, or faint.
• Your drain suddenly stops draining and any of the above is happening.

The main signs of cholangitis are fever and chills, upper right belly pain, and jaundice. Do not wait for all of them. A fever alone is reason enough to seek emergency care when you have a biliary stent or drain.

Call the interventional radiology or oncology team right away if:

• You recently had an ERCP and have a fever above 100 °F (37.8 °C), belly pain or severe bloating, nausea or vomiting, or black stools. MedlinePlus lists these as reasons to call after ERCP.
• Daily output falls sharply, or the bag stays empty for several hours.
• Bile leaks around the tube and soaks the dressing or your clothes.
• The tube looks longer outside the skin, or the stitch or anchor has come loose.
• The skin at the site is red, hot, swollen, or leaking pus.
• Itching, pale stools or dark urine return after they had improved.
• Bile in the bag turns cloudy, thick or foul-smelling.

ERCP, or endoscopic retrograde cholangiopancreatography, is done through the mouth. A flexible scope goes down to the small intestine. A thin tube is then passed into the bile ducts. MedlinePlus lists risks such as bleeding, a hole in the bowel, and pancreatitis.

Percutaneous transhepatic biliary drainage goes through the skin. A needle passes into the liver and a bile duct. A stent or drain may be left in place. MedlinePlus says this may be done if ERCP cannot be done or did not clear the blockage.

NCI says a stent or drain may send bile into the small intestine, or into a bag outside the body. Know which one you have:

• External drain. Bile runs into a bag.
• Internal-external drain. The tube can drain into the bowel, and may be capped or connected to a bag.
• Internal stent alone. Nothing outside at all.

Stents come in different materials. Ask which type was used for you, and why. Stents can block or move and may need to be changed. Ask at the time of placement whether an exchange is already booked, and who to call when jaundice returns.

Follow the written care plan from the team that placed the drain. Ask them to write down:

• where the bag should sit compared with the drain site, in bed and when you are up
• when to empty it, and how to record the amount and color each day
• how and when to change the dressing
• how to secure the tube so it does not snag or kink

Wash your hands before and after touching the tube, bag or dressing. Do not flush, cap, uncap, clamp or reposition the drain unless you have been trained to do that exact task. Report any leak early.

When bile drains again, the signs of the blockage should ease. Watch the yellow in your skin and eyes, the color of your urine and stools, and the itch.

If those signs come back, the system may have blocked. Say so plainly on the phone: "My jaundice is coming back and I have a biliary stent." That sentence gets the right person on the line.

• MedlinePlus (National Library of Medicine) — Bile duct obstruction
• MedlinePlus (National Library of Medicine) — Cholangitis
• MedlinePlus (National Library of Medicine) — ERCP
• MedlinePlus (National Library of Medicine) — Percutaneous transhepatic cholangiogram
• National Cancer Institute — Bile Duct Cancer Treatment (PDQ)
• Centers for Disease Control and Prevention — Watch Out for Fever
• National Cancer Institute — Infection and Neutropenia During Cancer Treatment