Liver & bile ducts

Dr Marios Agathangelou performs hepatobiliary (liver and bile-duct) interventions in Nicosia and Limassol, Cyprus — covered by GESY, €0 for GESY beneficiaries. Hepatobiliary interventions treat conditions of the liver and bile ducts from within: blocked ducts are drained and stented, tumours are treated in place with ablation or embolization, and portal-vein procedures prepare the liver for surgery or relieve portal hypertension (TIPS).

Each procedure is performed through a 1–2 mm incision under continuous imaging guidance — a minimally invasive alternative to major surgery, with relief of jaundice and liver-related symptoms and a faster recovery than open procedures.

Minimally invasive Image-guided precision Outpatient or short stay Relief of jaundice

The procedure is fully covered by GESY. It is done as an inpatient admission, and that admission includes the treatment — you pay nothing for the procedure.

Separately, the outpatient visit — the initial assessment, where it is decided whether the treatment suits you — may carry a small co-payment, usually €0–10, as any specialist visit within GESY does.

The co-payment is per activity, and it stops once your total co-payments for the year reach €150 — past that you pay nothing. Some categories of beneficiary have different limits.

Both need a valid referral, from your personal doctor or from a specialist.

Outside GESY, or with private insurance? We provide the documentation your insurer asks for, and a clear cost estimate at your consultation, before you decide anything.

Liver and bile duct procedures solve specific problems: they relieve bile ducts blocked to the point of jaundice, place a stent where a narrowing will not resolve otherwise, lower the pressure in the portal vein when it is causing bleeding or fluid build-up (TIPS), and prepare the liver before major surgical resection. For liver tumours, see the tumour treatment page.

TIPS effectively lowers pressure in the portal vein and, in selected patients with cirrhosis, has been shown to prolong transplant-free survival. It carries a specific price you should know beforehand: hepatic encephalopathy — confusion, drowsiness, disturbed thinking — occurs in a substantial proportion of patients afterwards. It is usually manageable with medication and, less often, by modifying the shunt itself, but it is not rare and it should not be something you discover afterwards.

Most people notice the drain more than the procedure itself: soreness where the catheter enters, and a bag that needs looking after in the first days.

The catheter passes through the liver, and that is where the main risk comes from: bleeding into the bile ducts. In a series of 63 patients it affected about one in twelve, was mild in all of them, and settled without a second procedure.

The second risk is infection. Bile ducts that are already blocked are often already infected, and handling them can send bacteria into the bloodstream. That is why antibiotics are given beforehand, and why a fever after drainage is never ignored.

For a blockage high up, at the hilum of the liver, the percutaneous route succeeded about three and a half times more often than the endoscopic one, with fewer repeat procedures.

Lower down the biliary tree, though, the literature does not favour our own route. Where endoscopy has failed, drainage guided by endoscopic ultrasound had fewer adverse events and fewer catheters that block than the percutaneous approach. It is part of the discussion before the route is chosen.

Drainage relieves the jaundice and buys time. It does not shrink the tumour or correct the narrowing pressing on the duct; those are treated separately, and the plan is set in advance.

For TIPS, the risk of encephalopathy is not the same in every liver. Where a spontaneous portosystemic shunt is already present, the risk is about two and a half times higher — and that shunt can be embolized in the same sitting, which lowers it.

What goes in, where, and for how long is decided by the cause of the blockage and by what follows. You will see it on your own imaging before anything is decided.

Clinical statements on this page follow published reviews of TIPS outcomes and complications, meta-analyses comparing percutaneous, endoscopic and endoscopic-ultrasound biliary drainage, and a published series of percutaneous transhepatic drainage. They describe these procedures in general; they are not advice about your case.

BOOK A CONSULTATION +357 96 973434