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Percutaneous Transhepatic Cholangiography (PTC)

Image-guided imaging and drainage of the obstructed biliary system

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Radyoloji department. Book Appointment →

What is Percutaneous Transhepatic Cholangiography (PTC)?

Percutaneous transhepatic cholangiography (PTC) involves direct puncture of an intrahepatic bile duct under ultrasound and fluoroscopic guidance, followed by injection of iodinated contrast to image the biliary tree. PTC is now mostly performed in conjunction with percutaneous transhepatic biliary drainage (PTBD) for patients with biliary obstruction in whom ERCP has failed or is not anatomically feasible.

Indications include malignant biliary obstruction (pancreatic head, cholangiocarcinoma, hilar tumors), benign post-surgical strictures, choledocholithiasis after Roux-en-Y, post-transplant anastomotic strictures and primary sclerosing cholangitis. PTBD relieves jaundice, treats cholangitis, allows brachytherapy or stenting and serves as a bridge to definitive surgery. Major complications include hemobilia, sepsis and bile leak.

Symptoms

Obstructive jaundice with elevated bilirubin
Cholangitis with fever, jaundice and right upper quadrant pain
Failed ERCP for biliary access
Roux-en-Y anatomy precluding ERCP
Hilar cholangiocarcinoma needing drainage
Post-transplant biliary anastomotic stricture
Bile leak after hepatobiliary surgery
Pruritus from chronic obstructive jaundice

Risk Factors

Severe coagulopathy (correctable)
Refractory ascites
Hydatid cyst in puncture path
Multiple intrahepatic metastases
Severe contrast allergy
Active sepsis without antibiotic coverage
Severe right heart failure
Uncontrolled hyperthyroidism

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Painless or painful jaundice
  • Fever and jaundice with abdominal pain (cholangitis)
  • Pruritus with elevated bilirubin
  • Confirmed biliary obstruction needing drainage
  • Failed endoscopic stenting
  • Bile leak after surgery
  • Pre-operative biliary decompression

Treatment Methods

01
Pre-procedural correction of coagulopathy (INR < 1.5, platelets > 50K)
02
Broad-spectrum antibiotic prophylaxis (piperacillin-tazobactam)
03
Ultrasound-guided 22-gauge needle puncture of intrahepatic duct
04
Cholangiogram performed with iodinated contrast under fluoroscopy
05
Wire access into common bile duct and duodenum if possible
06
Internal-external drainage catheter (8.5-10 Fr) placement
07
Self-expanding metal or plastic stenting for malignant strictures
08
Post-procedure monitoring for hemobilia, sepsis and bile leak
09
Catheter exchange every 8-12 weeks for patency

Which Department to Visit?

You can visit our Radyoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.