PTBD (Percutaneous Transhepatic Biliary Drainage)
PTBD is a minimally invasive procedure in which a thin tube called a catheter is inserted through a skin puncture into the liver to allow bile drainage. The bile which is drained will be collected in an attached drainage bag. This procedure is performed under image-guidance.
The most common reason for having a PTBD is blockage of the drainage system of the liver, called the bile ducts. When this happens, the bile, which normally drains down a narrow muscular passage, called the common bile duct, into the duodenum is backed up, and the bile ducts in the liver become dilated. This blockage can affect liver function and cause jaundice (yellowish discolouration of the eyes and skin) and severe itch.
Sometimes, the blocked system can get infected, making you severely ill. Causes of blockage of the ducts include stones and tumours. The signs and symptoms of blocked bile ducts are jaundice, itching,dark urine, chalk-coloured stools, nausea and loss of appetite. This condition is potentially serious and needs to be treated immediately.
Conditions treated with PTBD
Percutaneous transhepatic biliary drainage is a procedure used to diagnose and treat biliary system conditions. It is primarily used to treat conditions that cause blockages or obstructions in the biliary tree, such as :
- Gallstones: PTBD can be used to remove gallstones that are obstructing bile flow. It is also useful in the treatment of gallbladder inflammation and infection.
- Biliary strictures: PTBD procedure can widen narrowed areas in the biliary tree caused by scarring or inflammation.
- Bile duct infection: Bile duct infection is uncommon but potentially dangerous. PTBD can be used to flush out the infection and provide relief.
- Pancreatic pseudocyst: If a cyst forms in the pancreas, PTBD can drain it and relieve pressure. A radiologist usually performs the procedure.
- Malignant biliary cancers: In the case of biliary cancers, PTBD can be used to relieve symptoms and reduce the risk of complications.
- Chronic pancreatitis: PTBD can treat chronic pancreatitis, which causes pancreas inflammation.
- Foreign body in the bile duct.
- Tumors: PTBD can help diagnose tumors of the biliary tree and remove them if necessary.
- Pancreatic cancer: In some cases, a PTBD procedure can relieve pressure or reduce the risk of complications.
- Lymph node enlargement in the region of the liver and pancreas due to various types of tumors.
Types of drainage
Depending on the drainage site, these can be classified into three types:
- Internal: the prosthesis used in the obstruction point connects the prestenotic and poststenotic segments. The drainage is always directed toward the duodenum's interior.
- External: the catheter is lodged above the obstruction, and the bile drainage is always outward.
- Internal/external: The distal end of the catheter with orifices is inserted into the duodenum; if the external drainage is open, bile leaks to the outside; if it is closed, bile drains to the duodenum like internal drainage.
Procedure
Before the procedure
- A blood test may be required to test for any blood clotting problems.
- If you are on any medication, kindly inform your doctor.
- If you are taking any blood thinners, they may have to be stopped for 3-5 days prior to the procedure. Your doctor will guide you on this. Similarly, diabetic medication may have to be halted until after the procedure, as fasting may be required for the procedure.
- In general, fasting 4-6 hours prior to the procedure is recommended. This is especially so if sedation or general anesthesia is required.
- If the procedure is to be performed as an outpatient, please arrive at least 20 minutes before your procedure time. If the procedure is to be performed as a day case or inpatient, please arrive at least 2 hours before the procedure time.
- Pre-procedure broad-spectrum antibiotic prophylaxis is given to all patients undergoing biliary drainage to avoid transient bacteremia commonly occurring during the procedure.
During the procedure
- The procedure is performed by an interventional radiologist who utilizes image guidance for a minimally invasive procedure.
- This is typically done under conscious sedation. An anesthesiologist will provide sedation and monitor your vital signs and breathing to ensure your stability and comfort throughout the procedure.
- Under aseptic conditions, a local anesthetic is injected into the area where the catheter will be inserted.
- A fine needle is inserted into the bile ducts of the liver using ultrasound and fluoroscopic (real-time X-ray imaging) guidance. To confirm successful entry into the duct system, an X-ray dye (contrast agent) will be injected.
- Under fluoroscopic guidance, a fine guidewire and catheter are then manipulated past the obstruction to enter the duodenum.
- A biliary drainage catheter is inserted over this wire, extending from the duodenum to the liver and out to the skin. This will then be attached to the skin at the puncture site and connected to a drainage bag to collect the bile draining from the liver through this catheter.
After the procedure
You will be shifted back to your room after a brief period of monitoring in the recovery room by the nursing staff. The duration of the drainage catheter may vary depending on the reason for its insertion. Your doctor will decide how long it is necessary.
Benefits and Risks
Benefits
- The percutaneous transhepatic biliary drainage procedure is associated with high success rates of biliary drainage and lower rates of cholangitis.
- The catheter will unblock bile flow from the liver to the small intestine. As a result, the infection and pain caused by the obstruction will be relieved, and the liver function will be preserved.
Risks
As with any other medical procedure, there are a few risks and complications associated with the PTBD procedure. These include
PTBD Care at Medicover
Medicover Hospitals have the best team of interventional radiologists. All the doctors are highly trained, knowledgeable and have extensive experience in their field. Our interventional radiologists and team, with their expertise and skills, handle percutaneous transhepatic biliary drainage with impeccable precision. Our doctors are well-versed and practice the most advanced techniques to help deliver the best clinical outcomes. The team is also well-equipped with advanced technology, high-end equipment to achieve the best and most precise results. We provide the highest level of excellence and precision through quality diagnosis and treatment.
