Ep. 421 A Deep Dive into Biliary Interventions with Dr. Brian Holly

In this episode of the BackTable Podcast, host Dr. Michael Barraza interviews guest Dr. Brian Holly about different surgical scenarios relating to biliary interventions. Dr. Holly is a practicing interventional radiologist and Assistant Professor of Radiology and Radiological Sciences at Johns Hopkins University.

The doctors delve into various techniques including the usage of ultrasound, managing non-dilated and dilated systems, as well as handling specific clinical scenarios such as malignant obstructions, benign biliary strictures, and postoperative bile leaks. The podcast also briefly discusses the controversial topic of placing internal biliary stents and the challenges faced with managing biliary strictures and leaks.

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SHOW NOTES

00:00 - Introduction

01:53 - Discussion on IR Training at Johns Hopkins

04:09 - Overview of Biliary Interventions

08:31 - Challenges and Techniques in Biliary Access

19:28 - Approach to Non-Dilated Collecting System

28:07 - Dealing with Dilated Systems and Obstructions

32:56 - Biopsy Techniques for Malignant CBD Strictures

39:30 - Approach to Benign Biliary Strictures

41:48 - Use of Internal Stents in Biliary Procedures

44:51 - Managing Bleeding in Biliary Procedures

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RESOURCES

The Hepaticojejunostomy Technique with Intra-Anastomotic Stent in Biliary Diseases and Its Evolution throughout the Years: A Technical Analysis:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4846744/

Percutaneous Transhepatic Cholangiography and Intraductal Radiofrequency Ablation Combined with Biliary Stent Placement for Malignant Biliary Obstruction:

https://www.jvir.org/article/S1051-0443(15)00166-9/abstract