Percutaneous Transhepatic Biliary Drainage (PTBD) is a life-saving image-guided procedure that drains bile from a blocked bile duct directly through the liver, when ERCP (endoscopic drainage) has failed or is not possible. It rapidly relieves obstructive jaundice, controls cholangitis (biliary infection) and prepares the patient for further oncological treatment, surgery or stenting. At our Bathinda clinic, PTBD is performed by Dr. Ambrish Raja under combined ultrasound and fluoroscopy guidance, with same-day or next-day jaundice relief.
When Is PTBD Needed?
- Obstructive jaundice due to malignancy — cholangiocarcinoma, gallbladder cancer, pancreatic head cancer, ampullary tumour, peri-hilar Klatskin tumour
- Failed ERCP — when endoscopic stenting is not possible
- Acute cholangitis with sepsis needing emergency biliary decompression
- Benign biliary strictures — post-surgical or inflammatory
- Pre-operative biliary decompression before major liver/pancreatic surgery
- Bile leak after surgery
How PTBD Is Performed
- Pre-procedure work-up: PT/INR, platelet count, broad-spectrum IV antibiotics, recent CT/MRCP review.
- The procedure is done under local anaesthesia with mild sedation.
- Under ultrasound guidance, a fine needle is passed through the skin and liver into a dilated bile duct.
- A guidewire and catheter are negotiated across the obstruction under fluoroscopy.
- An internal-external biliary drainage catheter (8-10 Fr) is positioned across the stricture into the duodenum.
- The catheter is fixed to the skin and connected to a drainage bag.
- Bile starts draining immediately — bilirubin levels usually fall by 50% within 5-7 days.
Internal vs External Drainage & Biliary Stenting
The first-stage drainage is usually internal-external (bile flows both into the bag and into the bowel). Once the patient stabilises, the catheter can be replaced with an internal metallic biliary stent — eliminating the external bag and restoring near-normal physiology.
Benefits of PTBD
- Rapid relief of obstructive jaundice and severe itching
- Controls life-threatening biliary sepsis
- Improves liver function before chemotherapy or surgery
- Prolongs and improves quality of life in inoperable malignancy
- Avoids major surgery in unfit and elderly patients
Recovery & Catheter Care
- Hospital stay: 2-4 days for first-time PTBD
- Daily output is recorded; the catheter is flushed with saline once or twice a day
- Routine catheter exchange every 2-3 months to prevent blockage
- Detailed home-care instructions and 24/7 phone support are provided
Frequently Asked Questions
Is PTBD a major operation?
No — it is a minimally invasive image-guided procedure done under local anaesthesia with sedation, through a tiny puncture on the right side of the abdomen. There is no surgical incision.
How quickly will jaundice improve?
Bile drainage starts immediately. Bilirubin typically falls by 30-50% in the first week and continues to normalise over 2-4 weeks if the cause is treatable.
Can the external bag be removed later?
Yes — once stable, the external catheter can be replaced with an internal metallic biliary stent, removing the need for an external bag.
Is PTBD covered by insurance?
Yes. PTBD is a recognised therapeutic procedure and is covered by all major health insurance and TPA panels.
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