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Percutaneous Transhepatic Cholangiography (PTC) Intervention

Biliary tract drainage and diagnostic imaging: ERCP-failed cases

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) Intervention?

PTC was first described by Burcharth in the 1970s and modernized today with the Seldinger technique. Indications: ERCP failure or impossibility (Roux-en-Y reconstruction, gastric bypass), Bismuth III-IV hilar cholangiocarcinoma, complete biliary obstruction, complex hepaticojejunostomy, biliary leak.

Technique: under fluoroscopic and ultrasound guidance, the right (mid-axillary line, 8-9 ICS) or left (subxiphoid) bile ducts are accessed with a 22G Chiba needle, contrast is given to perform cholangiography. Then 0.018'' guidewire, sequential dilation, internal-external drainage catheter (8-10 Fr) is placed.

Therapeutic procedures: stent placement (10-14 mm self-expanding metallic, malignancy), balloon dilation (benign stricture), stone removal, biopsy. Complication rates: 5-10% (bleeding, biliary leak, sepsis, pneumothorax). Mortality 1-2%. Antibiotic prophylaxis (3rd generation cephalosporin) is mandatory; high success rate (90-95%) with experienced center.

Symptoms

Persistent jaundice and elevated bilirubin (>5 mg/dL)
ERCP failure history
Postoperative biliary anatomy (Roux-en-Y, gastric bypass)
Bismuth III-IV cholangiocarcinoma
Complete biliary obstruction (no ERCP access)
Suspected biliary leak (post-cholecystectomy)

Risk Factors

Coagulopathy (INR >1.5, platelet <50,000)
Massive ascites (relative)
Severe COPD (anesthesia tolerance)
Liver tumor in access route
Severe sepsis (delay until controlled)
Pregnancy (radiation exposure)

When to See a Doctor?

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

  • Persistent obstructive jaundice
  • Failed ERCP
  • Cholangiocarcinoma diagnosis
  • Severe right upper quadrant pain + fever (cholangitis)
  • Postoperative biliary leak suspicion
  • Persistent elevation in liver enzymes

Treatment Methods

01
Internal-external drainage catheter (initially)
02
Self-expanding metallic stent (10-12 mm, malignancy)
03
Balloon dilation (benign stricture)
04
Plastic stent (temporary, in benign cases)
05
Antibiotic prophylaxis (3rd generation cephalosporin)
06
Catheter care (weekly flushing, monthly exchange)

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.