Percutaneous Transhepatic Cholangiography

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What is Percutaneous Transhepatic Cholangiography?

PTC is a medical procedure that detects bile ducts through x-ray. These ducts facilitate the flow of bile juice from the liver to the small intestine and gallbladder. In this procedure, contrast is injected in more than one bile duct and often in the duodenum. Percutaneous transhepatic cholangiography is usually performed under the guidance of ultrasound and fluorescence.

Why is Percutaneous Transhepatic Cholangiography needed?

PTC detects the reason for obstruction in the bile duct – it is the first step of a procedure consisting of two steps for treating blockage of the bile duct. For planning treatment, PTC is conducted to form a path of the bile duct. Then a thin flexible tube or stent is placed into the duct – bile is extracted from the body using this drain through a process called percutaneous biliary drainage. 

Bile is a secretion by the liver – it helps in breaking body fats. Bile juice consists of bile salt, waste products and cholesterol. Bile duct blockage or obstruction can result in other health problems like skin itching, infection of the pancreas, gallbladder or liver and jaundice. It is considered a life-threatening disorder of the liver.

Types of bile ducts

Intrahepatic ducts and Extrahepatic ducts are two types of bile ducts. 

• Intrahepatic ducts: there is an interconnected system of small ducts called intrahepatic ducts. They are situated inside the liver and facilitate the flow of bile from the liver to the extrahepatic ducts. 
• Extrahepatic ducts: this duct has two parts. One placed on the right side and another on the left side of the liver. While exiting the liver, they join each other to form the hepatic duct. The hepatic duct reaches the small intestine.  

Causes of biliary obstruction: several factors responsible for biliary obstruction include disorders of ducts, liver, pancreas, gallbladder and small intestine. Some common causes are gallstones, trauma, cysts, enlargement of lymph nodes, injury from surgery of liver or gallbladder, infections, inflammation in bile ducts, narrowing of bile ducts also known as a biliary stricture, tumours in the liver, bile ducts, pancreas and gallbladder, parasites, mild pancreatitis, chronic damage of the liver, cirrhosis and congenital cyst. 

Some rare causes of biliary obstruction involve pancreatic cancer, the genetic history of gallstones, obesity, extreme loss of weight, sickle cell anaemia occurs due to red blood cells breakdown, severe pancreatitis and severe injury in the abdomen. 

Symptoms of biliary obstruction: though symptoms of this health problem depend on causes main symptoms include jaundice or yellow eyes and skin colour, nausea, weight loss, fever, vomiting, dark colour of urine, pain on the right side of the abdomen, persistent itching and light colour of stool. 

Risks due to biliary obstruction: if not treated on time, it can be hazardous to health and can, eventually, lead to the death of a patient. Few risks involved are chronic infection and other diseases of the liver, biliary cirrhosis, harmful buildup of bilirubin and sepsis. 

Various tests and treatment procedures are available for curing this obstruction of bile ducts and one of them is percutaneous transhepatic cholangiography which is a highly reliable diagnostic procedure. For avoiding this problem naturally, one should increase intake of fibre in the diet, reduce intake of saturated fats and sugar in the diet as it leads to stone in the gallbladder and prevent obesity with light exercises. 

Preparation for percutaneous transhepatic cholangiography

Primary tests are conducted before PTC like CT scan or other imaging exams can be conducted for planning the type of treatment. Imaging of ducts provides information regarding the pattern of drainage of ducts. It helps in deciding the lobe approach which is an initial process. To determine blockage or leakage of bile ducts, there are several contrast agents such as iminodiacetic acid, it is a hepatobiliary agent and radionuclide scintigraphy commonly administered with technetium 99-m.

Antibiotics are administered to treat gram-negative bacteria, sometimes even anaerobic or gram-positive bacteria are considered as well. In the case of malignancy drainage of the biliary, IV fluids are injected. Its main purpose is the reduction of chances of hepatorenal failure resulting due to dehydration which occurs as a result of iatrogenic and volitional nothing through the mouth. Parameters like coagulation parameters must be corrected. There is a condition where INR is raised before hepatic puncture. In this case, frozen plasma is delivered to the body after, before or during the process as the life of this frozen plasma is considerably short. 

Percutaneous transhepatic cholangiography test procedure

Obstruction of bile ducts can be benign or malignant. Commonly found disorders caused by benign form are sclerosing cholangitis and stenoses related to a liver transplant. Percutaneous transhepatic cholangiography is a minimally aggressive procedure as compared to others. Generally, in conjunction with PTC, ultrasound, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography and CT scan are also conducted. 

After this, the procedure is performed by a radiologist. The patient lies on his back on the diagnostic table. The Middle and upper area of the abdomen is cleaned and anaesthesia is administered to numb the sensation of pain or discomfort. Ultrasound and x-rays are used for determining the exact location of bile ducts and liver in the body. Then a thin, long and flexible wire is inserted inside the liver through the skin under the guidance of a camera and monitoring screen. With the help of this wire, a contrast agent is injected inside bile ducts. The function of this dye or contrast agent is to highlight specific areas of defect. Proper images of bile ducts and small intestines are obtained as it travels through these ducts to other parts.  

Recovery from percutaneous transhepatic cholangiography

After the procedure, the patient is kept under supervision for some time while he overcomes the effect of anaesthesia. There is no complication or harmful reaction due to a contrast agent during the recovery period. The patient is discharged after 2-3 hours as he gains his consciousness. There is no particular diet or daily routine after PTC. 

Percutaneous transhepatic cholangiography complications

PTC complications are infections, poisoning of blood often known as sepsis, damage to surrounding organs and liver, inflammation in the intrahepatic and extrahepatic ducts and extreme loss of blood. 

Percutaneous transhepatic cholangiography benefits

Benefits of percutaneous transhepatic cholangiography include normal functioning, appearance and size of bile ducts, highly reliable procedure, reduced risk of reaction or infections, highly successful about 80%, better utility and features as compared to other similar tests, less aggressive and effective in curing anorexia, jaundice, pain and nausea. It is considered as the best method for removing stones of bile ducts, diagnosis of affected tissues and treating stricture of the bile duct, 

FAQs

What is the cost of percutaneous transhepatic cholangiography?

PTC cost ranges between $400 and $1,000. The cost of percutaneous transhepatic cholangiography differs from procedure to procedure depending on the facilities of a hospital and the cause and severity of a problem. 

What are the side effects of percutaneous transhepatic cholangiography?

PTC side effects are uncommon in this process but some of them are peritonitis, sepsis and haemorrhage. A rare side effect is a pneumothorax, which occurs due to the right side approach. 

How to prepare for percutaneous transhepatic cholangiography? 

Do not eat or drink anything before the process for at least 6-7 hours and inform the doctor about all health conditions like allergies, bleeding disorders and pregnancy – drugs like Warfarin, Pradaxa and Plavix are injected for thinning the blood.

How long does percutaneous transhepatic cholangiography take?

PTC takes almost 1 to 2 hours for completion. Preparation takes additional time, however, an overnight stay is not required and the patient is discharged the same day as the procedure. 

Is percutaneous transhepatic cholangiography painful?

No PTC is not painful, anaesthesia is given before the procedure which numbs the pain. Sometimes discomfort is experienced during the procedure, managed by sedation.