PTC, PTBD & CBD Stenting
Minimally invasive solutions for bile duct obstructions and jaundice
Biliary Drainage & Stenting Procedures
PTC (Percutaneous Transhepatic Cholangiography)
Diagnostic imaging of bile ducts using contrast dye to identify obstructions
PTBD (Percutaneous Transhepatic Biliary Drainage)
Therapeutic drainage procedure for relieving bile duct obstructions
CBD Stenting (Common Bile Duct Stenting)
Permanent stent placement to maintain bile duct patency long-term
Conditions Treated with Biliary Interventions
Common Causes of Bile Duct Obstruction
- •Malignant tumors: Pancreatic cancer, cholangiocarcinoma, metastatic disease
- •Benign strictures: Post-surgical, inflammatory, or idiopathic narrowing
- •Bile duct stones: Choledocholithiasis not removable by ERCP
- •Infection/inflammation: Cholangitis, primary sclerosing cholangitis
Symptoms Addressed
- •Jaundice: Yellow skin/eyes from bilirubin buildup
- •Pruritus: Severe itching from bile salt deposition
- •Abdominal pain: Typically in right upper quadrant
- •Cholangitis: Fever, chills from infected bile
Procedure Details: What to Expect
Preparation
Patients typically fast for 6-8 hours prior. Blood tests check coagulation status. Prophylactic antibiotics may be given.
The procedure is performed under local anesthesia with conscious sedation in an interventional radiology suite.
PTC Imaging Phase
Using ultrasound guidance, a fine needle (22G Chiba) accesses the bile ducts. Contrast injection under fluoroscopy maps the biliary anatomy and identifies obstruction sites.
PTBD Drainage
After accessing the bile duct, a guidewire is advanced across the obstruction. A drainage catheter (8-12Fr) is placed either:
- Externally: Drains bile to a collection bag
- Internally-externally: Bile drains both to bowel and externally
- Internal: Bile drains to bowel only (preferred when possible)
CBD Stenting
For permanent relief, a metal or plastic stent is deployed across the obstruction. Metal stents (uncovered or covered) typically last longer (6-12 months) than plastic stents (3-6 months).
Procedure Outcomes & Success Rates
90-95%
Technical success rate for PTBD
70-80%
Clinical success (jaundice resolution)
3-5%
Major complication rate
*Success rates vary based on obstruction cause, location, and patient factors
Advantages Over Surgical Alternatives
Key Benefits
- ✓Minimally invasive: Small skin nick vs. large surgical incision
- ✓Faster recovery: 1-2 day hospitalization vs. 5-7 days for surgery
- ✓Lower risk: Especially beneficial for elderly or frail patients
- ✓Repeatable: Stents can be replaced if they become blocked
- ✓Palliative option: For inoperable malignant obstructions
Potential Risks
- •Bleeding (1-3%): From liver puncture, may require transfusion
- •Infection (2-5%): Cholangitis or catheter site infection
- •Bile leakage (3-5%): May cause peritonitis if severe
- •Stent dysfunction: Occlusion or migration requiring revision
- •Pneumothorax: Rare lung complication from high puncture
Patient Experiences
"After being diagnosed with pancreatic cancer, I developed severe jaundice. The PTBD procedure gave me immediate relief, and the stent allowed me to continue chemotherapy without surgery."
- Robert T., Pancreatic Cancer Patient
"My bile duct was blocked by a large stone that couldn't be removed by ERCP. The interventional radiologists placed a drainage tube first, then later a stent. I avoided major surgery and was home in two days."
- Maria S., Bile Duct Stone Patient
Frequently Asked Questions
How long does a biliary stent last?
Metal stents typically remain patent for 6-12 months, while plastic stents last 3-6 months. Stent lifespan depends on the underlying condition (malignant vs. benign) and individual factors.
Is PTBD painful?
Most patients experience only mild discomfort during the procedure thanks to local anesthesia and sedation. Some post-procedure pain at the catheter site is common but manageable with medications.
Can I bathe with a biliary drain?
Sponge bathing is recommended initially. After 5-7 days, brief showers are usually permitted if the catheter site is covered with a waterproof dressing. Always consult your care team for specific instructions.
When will my jaundice improve?
Bilirubin levels typically start dropping within 24-48 hours after successful drainage. Skin yellowing may take 1-2 weeks to fully resolve as bilirubin clears from tissues.
Biliary Emergency Signs
- •Severe abdominal pain with fever
- •High fever (101°F) with chills
- •Drainage tube dislodgement
- •Sudden decrease in bile output
- •Bleeding at catheter site
Procedure Quick Facts
Duration
1-2 hours (varies by complexity)
Anesthesia
Local with conscious sedation
Hospital Stay
1-2 days for observation
Recovery Time
3-5 days to normal activity
Follow-up
1 week post-procedure
Ideal Candidates
- •Patients with obstructive jaundice
- •Failed or contraindicated ERCP
- •High surgical risk patients
- •Malignant biliary obstruction
- •Need for preoperative drainage