Percutaneous Transhepatic Cholangiogram (PTC)
Date issued: November 2024
For review: November 2026
Ref: B-297/RA/Imaging/ Percutaneous Transhepatic Cholangiogram PTC and Drainage V2
PDF: Percutaneous Transhepatic Cholangiogram PTC and Drainage.pdf [pdf] 211KB
This leaflet tells you about having a Percutaneous Transhepatic Cholangiogram (PTC), drainage +/- stent insertion. It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor but can act as a starting point for such discussions. If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.
Referral and consent
The referring clinician should have discussed the reasons for this examination with you in the clinic and you should make sure that you understand these before attending. You will be referred to an Interventional Radiologist for this procedure.
Interventional Radiologists are doctors who have trained and specialised in imaging and x-ray treatments.
Before the procedure you will need to sign a consent form, if one hasn’t previously been completed. This is a legal requirement and ensures that you are fully informed about your procedure.
If after discussion with your hospital doctor or radiologist, you do not want this examination then you can decide against it. If the radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary, then they will explain this to you and communicate with the referring clinician. You will return to your referring clinician for review.
At all times the radiologist and referring clinician will be acting in your best interests.
What is a percutaneous biliary drain?
A percutaneous biliary drainage is a procedure in which a small plastic tube (drain) is inserted into the liver through the skin to drain the bile. It is sometimes combined with taking a picture of the bile ducts to see where the blockage might be. This is known as a Percutaneous Transhepatic Cholangiogram (PTC).
What is biliary stent?
A biliary stent is a special device made of metal/plastic mesh that is placed across a narrowing or blockage to keep the biliary vessel open.
Why do you need a PTC, drain +/- stent?
Biliary drainages are typically performed because you have become jaundiced (yellow) and extremely itchy. This is because the bile cannot flow normally into the gut and the condition makes you susceptible to infection. The most common reasons for this are gallstones and pancreatic masses, although there are other causes.
Other imaging that you probably have had performed, such as an ultrasound scan or a Computed Tomography (CT) scan, will have shown that there is a blockage or leak within the bile ducts. The doctors looking after you have decided that you need a PTC and drainage to obtain more information about your liver problem. The information gained will help the doctors plan the treatment of your condition.
Sometimes, the biliary drainage procedure may be extended by placing a permanent plastic or metal stent across the blockage in the bile duct. Stents are usually inserted a few days after the initial drainage procedure, and they keep the narrowed duct open without the need for a catheter.
To help insert the stent, biliary dilatation might be necessary. This involves dilating (stretching) a segment of the biliary vessel.
Are there any risks?
PTC and drainage is a safe procedure, but as with any medical procedure there are some risks and complications that can arise.
If the bile is infected, although you may be on antibiotics, there is a small risk that infection might be released into your bloodstream, making you unwell for a period.
There is a risk of bleeding, though this is generally very slight. If the bleeding were to continue, then it is possible that you might need a blood transfusion. Very rarely, an operation or another radiological procedure is required to stop the bleeding.
A bile leak may occur around the puncture site which causes pain/irritation of the lining of the abdomen.
If the bile duct becomes obstructed/blocked, we have options to reopen this during the procedure.
Very rarely a pneumothorax (collapsed lung) can be caused especially in patients with an enlarged liver or a low-lying lung. As lung is difficult to see on U/S then it can be accidently punctured. Depending on severity this can be left or treated with a chest drain.
Peritonitis is also a rare complication of a PTC due to a bile leak. This can be treated with antibiotics but may lead to surgery.
Some complications can be life threatening and although rare death should also be considered as a risk of this procedure.
If you are pregnant or suspect that you may be pregnant you should notify the department. A baby in the womb may be more sensitive to radiation than an adult. There is no problem with something like an x-ray of the hand or chest because the radiation field is at a safe distance from the foetus. However, special precautions are required for examinations where the womb is in, or near, the beam of radiation. If you are a female of childbearing age the radiographer will ask you if there is any chance of you being pregnant before the examination begins and you will be asked to sign a form. If there is a possibility of pregnancy, then your case will be discussed with the team looking after you to decide whether or not to recommend postponing the investigation.
There will be occasions when diagnosing and treating your illness is essential for your health and where the benefit clearly outweighs the small radiation risks. The procedure may go ahead after discussing all the options with you.
Are you required to make any special preparations?
Because this procedure can take some time, and occasionally can be painful, some Radiologists
prefer you to have a General Anaesthetic (GA). There are small risks associated with this which will be explained to you by your anaesthetist. Others may prefer sedation.
A PTC and drainage are usually carried out as a day case procedure.
For sedation/GA:
If you have a morning appointment, you will be asked to have nothing to eat from midnight although you may still drink water up to 6am then sips of water for the 2 hours before your examination.
If you have an afternoon appointment you may eat normally up to 6am and then water only up to 10am with sips of water for the 2 hours before your examination.
If it is decided that the procedure will be performed with just local anaesthetic, then you may eat and drink normally.
If your blood clotting is abnormal, you may be given special blood transfusions to try and correct this. If you have any concerns about having blood transfusions, you should discuss these with your doctor.
If you are taking warfarin, rivaroxaban, apixaban, ticagrelor (anticoagulants) this will be stopped before the procedure and you may require admission to hospital to give you an alternative.
If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the radiology staff before you have the test.
Who will you see?
A specially trained team led by an Interventional Radiologist within the radiology department. Interventional Radiologists have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.
Where will the procedure take place?
If you are having the procedure as a day case, then you will attend PIU/Postbridge ward prior. You will be asked to get undressed and put on a hospital gown. A small cannula (thin tube) will be placed into a vein in your arm. You may require a fluid drip to help your kidney function before the procedure. Our porters will collect you and bring you to the interventional radiology suite which is located within X-ray East. This is similar to an operating theatre into which specialised X-ray equipment has been installed.
What happens during the procedure?
Before the PTC and drainage, the Interventional Radiologist will explain the procedure and ask if you have signed a consent form. Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
You may receive a sedative to relieve anxiety or a GA, as well as an antibiotic. You will lie on the X-ray table, generally flat on your back and will have monitoring devices attached to your chest and finger.
You may be given oxygen if needed.
The procedure is performed under sterile conditions and the Interventional Radiologist and radiology nurse will wear sterile gowns and gloves to carry out the procedure. The procedure is performed using local anaesthetic and often sedation.
The skin at the side of your abdomen will be swabbed and covered with sterile towels. Local anaesthetic will be injected into the skin to numb the area. Once the skin is numb, a small needle is inserted into the bile ducts. A small amount of dye (contrast agent) is injected to allow images to be taken of the ducts. Once the Interventional Radiologist has enough information, either a drain will be left in place and connected to an external drainage bag, or a stent will be placed across the narrowed part of the biliary vessel.
Will it hurt?
If a GA is not performed, it may sting a little when the local anaesthetic is injected but this will soon wear off. When the catheter is placed in the liver, you may get a dull ache in the right shoulder. If you feel pain at any stage, please let the doctor and nurses know so that they can adjust the medications.
How long will it take?
Every patient is different, and it is not always easy to predict; however, expect to be in the radiology department for about 1-2 hours if sedation used or longer if a general anaesthetic is advised.
What happens afterwards?
You will be taken to theatre recovery for a couple of hours and then back to your ward. Nursing staff will carry out routine observations including pulse and blood pressure and will also check the treatment site. You will generally stay in bed for a few hours, until you have recovered.
Once the bile has been drained into the bag, your jaundice (yellow colour) and itching will improve, and you will feel much better.
If you have a GA, then an overnight stay is required.
Checking your wound site
Other Risks
PTC, drainage and stent insertion is a safe procedure but as with any procedure or operation complications are possible. We have included the most common risks and complications in this leaflet.
We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation.
Any exposure to ionising radiation (e.g. X-rays) has the potential to cause cancer later in life. This is much lower than the risk we all have of developing cancer in our life of ~1 in 3 and will be considered by the doctor before your procedure.
For information about the effects of X-rays read the publication: “X-rays how safe are they” on the Health Protection Agency
Finally
Some of your questions should have been answered by this leaflet but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact
Interventional Radiology Department
01752 432063 – Bookings Clerk
01752 430838 – IR Co-ordinator
Additional Information
Bus services:
There are regular bus services to Derriford Hospital. Please contact:
Car parking:
Hospital car parking is available to all patients and visitors. Spaces are limited so please allow plenty of time to locate a car parking space. A charge is payable.
Park and Ride:
Buses (1/1A/42C/34) run from the George Junction Park and Ride Mon-Sat (except Bank Holidays) every 15/20 mins from 6am. The last bus leaves the hospital at 11:30pm.
Plympton Park and Ride (52) runs from Coypool Park and Ride.
Parking is free although you will need to purchase a ticket to travel on the bus.
Patient Transport:
For patients unable to use private or public transport please contact The Patient Transport Service:
Devon GP: 0345 155 1009
Cornwall GP: 01872 252211
Comments and Suggestions
We welcome comments and suggestions to help us improve our service.
