Medical terminology in this article:

Percutaneous: Through the skin.
Transhepatic: Through the liver.
Biliary: refer to the gallbladder ducts.
Cholestasis: Condition is which bile cannot flow from the liver to the small intestine.

What is Percutaneous Transhepatic Biliary Drainage (PTCD) procedure?

Percutaneous transhepatic biliary drainage (PTCD) is the placement of a drain into bile ducts using a needle inserted through the skin. The procedure can be used to treat cholestasis disease, which may result from a narrowing or blockage in the bile ducts or bile leakage after an operation.

What is a Biliary Stenting procedure?

Biliary stenting is performed after biliary drainage if the blockage is malignant (cancerous) to keep the bile duct open and remove the drain used in PTCD. This involves putting a stent (a mesh metal tube) into the bile duct, which functions as a supportive skeleton to prevent the duct from closing.

What is a Biliary stone extraction procedure?

Biliary stone extraction is carried out using percutaneous access to the biliary tree (also known as the biliary tract). This is the path by which bile travels from the liver to the small intestine). Stones can be removed using a tiny basket or with a grasping device. Small and medium-sized stones can be pushed into the first part of the small intestine using a tiny balloon. If the stones are larger than 5 mm, a tiny balloon is used to dilate the entrance to the small intestine.

How does the procedure work?

Puncturing the bile duct is usually performed under sedation and local anesthesia. However, in rare cases and depending on the patient’s underlying condition and age, the procedure may be carried out under general anesthesia.

You will be given antibiotics beforehand to prevent infection. The procedure will be carried out in a sterile room while you lie on your back. The interventional radiologist will perform the procedure under X-ray guidance, though sometimes ultrasound is used in addition to fluoroscopy to confirm the direction for the puncture.

The interventional radiologist will pass a small needle through your skin into either your left or your right liver lobe. If the right liver lobe is punctured, this will be between your ribs and in the middle of your side. If your left liver lobe is punctured, the interventional radiologist will choose an entry site below the tip of your breastbone.

As the needle is withdrawn, the interventional radiologist will gently inject a diluted contrast agent, making the area look better under imaging. The interventional radiologist will then insert a guidewire into the bile duct, followed by a catheter. The guidewire and catheter are used together to move past the blockage and reach the intestine.

Once the interventional radiologist has removed this catheter, they will dilate the blocked liver tract so that the drainage catheter can be placed. A drainage catheter has multiple holes in its side, which drain the bile in two directions, outwards into a bag and inwards into the intestine. The bag will be attached to the skin and left in place for a few days until the biliary tract has decompressed. The catheter is daily flushed normal saline to keep the side-holes open when the bag is connected.

Why perform it?

If you are unsuitable for endoscopic procedures, PTCD is a possible alternative for you. It can be used to decompress the biliary ducts if a mass lesion or a stone blocks them or to bridge a hole if you experience bile leakage.

What are the risks?

Biliary procedures are safe, but complications might happen. Bleeding into the biliary tract is one of the most common complications, usually from a vein. It usually does not need any intervention as it heals on its own. A less frequent complication is major bleeding requiring a blood infusion or further interventions, such as surgery or embolization of the vessels.
PTCD procedure may cause transient fever, chills, and septicemia if you have a biliary infection.