BackTable Vascular & Interventional Ep. 576 Biliary Endoscopy Techniques: Managing Strictures & Drains with Dr. Ahsun Riaz
Sep 26, 2025
Dr. Ahsun Riaz, an interventional radiologist at Northwestern University, specializes in hepatobiliary services. In this discussion, he shares insights on managing biliary strictures using innovative techniques like endoscopic evaluation and radiofrequency ablation. He emphasizes the importance of distinguishing between benign and malignant conditions and outlines practical tips for biliary drain management. Riaz also highlights collaborative approaches to enhance patient care and improve long-term outcomes, ensuring comprehensive follow-up and minimizing drain duration.
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Building A Dedicated Hepatobiliary Service
- Dr. Ahsun Riaz built a hepatobiliary service because drains were being placed then forgotten and patients suffered chronic drains.
- He created a small dedicated team (two physicians, an APP, a nurse) to own drain patients and improve outcomes.
Drain To Drainable Liver Volume
- Get drains placed to maximize patient comfort and drain >50% of normal liver when the goal is bilirubin reduction.
- Place multiple drains when hilar disease involves several segments to reach that volume target.
Urgency And Timing For Drain Intervention
- Treat cholangitis as an emergency and intervene within 24–48 hours, using GA when possible.
- For non-emergent bilirubin reduction or benign post-transplant strictures, schedule definitive care within days to weeks and leave drains 4–6 weeks before reassessment.