Percutaneous Transhepatic Cholangiogram

Percutaneous transhepatic cholangiogram (PTC) is a diagnostic procedure in which x-ray images of the bile ducts are taken with contrast dye in order to locate a biliary blockage. Bile is a fluid produced by the liver that helps digestion by breaking down food. The bile ducts are a system of tubes that help facilitate the transfer of bile from the liver to the small intestine.

After being produced in the liver, bile is transferred through the bile ducts to the gallbladder, where it is stored. When a person eats, bile in the gallbladder passes through bile ducts into the duodenum (small intestine) where it aids in digestion. 

At MedStar Washington Hospital Center, our interventional radiology specialists are highly trained in percutaneous transhepatic cholangiogram procedures for the diagnosis of biliary blockages.

Why Percutaneous Transhepatic Cholangiogram (PTC) Is Performed

The results of a percutaneous transhepatic cholangiogram may indicate the cause of a bile duct blockage, and can help medical teams understand where exactly the blockage has occurred.

When the bile ducts are blocked, this can cause a buildup of bile in the liver, which can cause further health complications. Common reasons for a bile duct blockage include:

  • Gallstones
  • Narrowing of the biliary ducts
  • An infection that causes inflammation
  • Scarring of the liver
  • Parasites
  • Cysts
  • Tumors

What to Expect During Percutaneous Transhepatic Cholangiogram (PTC)

A percutaneous transhepatic cholangiogram generally takes about one hour to complete. The medical team will first administer an intravenous sedative to the patient, after which the upper-right area of the abdomen will be cleaned and injected with a local anesthetic. The radiologist uses real-time x-ray images to locate the liver and bile ducts. Then, he or she inserts a needle through the skin of the abdomen and to the bile ducts. Once the needle is inside the bile duct, the radiologist injects a contrast dye, and will then take additional x-ray images as the dye flows through the bile ducts. The contrast dye appears on the x-ray images, allowing the radiologist and medical team to see the exact location of the blockage.

The interventional radiologist will often be able to remove the blockage and treat its underlying cause in the same procedure.

Risks and Benefits of Percutaneous Transhepatic Cholangiogram (PTC)

Percutaneous transhepatic cholangiogram is very accurate in identifying the location and cause of a biliary blockage. This procedure can also be used for additional treatments of biliary blockages, including:

  • Draining an infected bile duct
  • Removing stones in the liver, gallbladder, or bile ducts
  • Dilation (expanding) of narrowed bile ducts

Percutaneous transhepatic cholangiogram is a relatively safe procedure. However, as with any procedure, there are risks. Risks associated with PTC include:

  • Bleeding
  • Damage to organs close to the bile ducts
  • Inflammation of the bile ducts

How to Prepare for Percutaneous Transhepatic Cholangiogram (PTC)

Each patient’s medical team will provide instruction to follow in the days before the procedure, which are designed to reduce the risk of complications. Some of these instructions will include:

  • Stop eating and drinking at least six hours before the scheduled time of the procedure.
  • Discontinue the use of blood thinning medications for a certain number of days before the procedure.

Post Percutaneous Transhepatic Cholangiogram (PTC)

Patients are generally allowed to go home the same day following a percutaneous transhepatic cholangiogram procedure, but will be asked to rest for several hours at home. Patients will also need to refrain from strenuous movements for a few days before returning to normal activities.

If the bile ducts were drained during the procedure, the patient may be leave the hospital with a small bag attached to a thin tube (called a catheter) outside of their body. Patients will be given thorough instructions for the care of these bags, as well as information on when they should return to the hospital to have the catheter removed.

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