PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE (PTBD)

Percutaneous Transhepatic Biliary Drainage (PTBD) is a minimally-invasive procedure for the treatment of a bile duct obstruction. The objective of the procedure is to locate the obstruction and/or to insert a temporary catheter to drain the bile or sometimes to insert a stent in the bile duct for a permanent cure. It is done in patients who are having a blockage in the bile duct due to cancer or stone where endoscopic drainage is not possible or in failed ERCP.

WHAT CAUSES BLOCKAGE OF THE BILE DUCTS?

There are several conditions that may cause this including:

• Gallstones (stones in the gallbladder or inside the bile ducts)
• Tumors of the bile ducts, liver, pancreas or gallbladder
• Pancreatitis (inflammation of the pancreas)
• Expanded lymph nodes in the region of the liver and pancreas
• Postoperative strictures
• Infection

WHAT ARE THE SYMPTOMS OF OBSTRUCTION OF BILE DUCTS?

Symptoms may include:

• Abdominal pain in the upper right side
• Dark urine
• Fever
• Itching
• Jaundice (yellow skin color)
• Nausea and vomiting
• Pale-colored stools

DIAGNOSIS

The following tests may be used to investigate a possible blocked bile duct:

• Abdominal ultrasound
• Abdominal CT scan
• Magnetic resonance cholangiopancreatography (MRCP)
• Endoscopic ultrasound (EUS)

HOW IS PTBD PROCEDURE PERFORMED?

The Percutaneous Transhepatic Biliary Drainage (PTBD) Treatment Procedure is performed by an Interventional Radiologist under sterile conditions. A local anesthetic is injected into the skin of the upper abdomen where the catheter will be inserted. A fine needle is then inserted under ultrasound and fluoroscopic direction into the bile ducts in the liver. X-ray dye (contrast agent) will be injected to confirm successful entry into the duct system. A fine guide wire and catheter are then controlled under fluoroscopic guidance, past the obstruction to entering the duodenum. A biliary drainage catheter is then passed over this wire, to stretch out from the duodenum, up through the bile ducts, liver, and onto the skin. This will then be secured to the skin at the puncture site and connected to a drainage bag to collect the bile which drains out of the liver through this catheter. Sometimes if no further plan of surgery is there, a self-expanding metal stent is placed across the block with no or minimally need for an external catheter. After the procedure, the patient is kept under observation for some time. Once stable, the patient can be discharged with appropriate instructions and follow-up.

BENEFITS OF PTBD:

• Minimally invasive procedure.
• No general anesthesia is required.
• The catheter will relieve the obstruction to the flow of bile from the liver to the small intestine. In doing so, infection and pain from the obstruction will be reduced and liver function is preserved.
• Often an endoscopic relief of the obstruction is not possible and a PTBD is the only means of relieving the obstruction.

RISKS AND COMPLICATIONS OF PTBD:

• Intra-abdominal bleeding; bleeding in the bile duct.
• Infection of the skin where the catheter is inserted and infection in the bile duct.
• Catheter dislodgement.
• Bile leakage.

These complications can be seen in about 5% of cases