Percutaneous transhepatic cholangiography, or PTC for short, is a diagnostic procedure of the bile ducts. PTC is generally used to diagnose and, if necessary, treat bile drainage disorders.
Here you will find further information as well as selected specialists and centers for percutaneous transhepatic cholangiography.
Percutaneous transhepatic cholangiography, or PTC for short, is an interventional imaging procedure. It is an X-ray examination that can be used to visualize the bile ducts inside and outside the liver.
Before the examination, the patient is injected with a contrast agent that is visible on the X-ray image. The path taken by the contrast medium in the bile ducts can be clearly seen in the X-ray image.
Doctors can use a PTC to diagnose an obstruction to the outflow of bile. If bile builds up in the bile ducts, this can cause various diseases. Gallstones or tumors often cause such an obstruction.
A diagnosed bile blockage can also be removed in the same step using the access created for a PTC. This is done using percutaneous transhepatic cholangiodrainage, or PTCD for short.
PTC is generally used to diagnose and, if necessary, treat bile drainage disorders. However, PTC is usually only used when it is not possible to diagnose and remove the bile blockage using the more gentle endoscopic retrograde cholangiography and pancreaticography(ERCP). In these cases, the bile duct orifice cannot be reached by endoscopic means.
A build-up of bile can have both benign and malignant causes. Benign diseases include gallstones, for example, which block the bile ducts and lead to a build-up of bile. Benign tumors and inflammatory changes can also cause an obstruction and make a PTC necessary.
The location of the gallbladder and the draining bile ducts in the body © lom123 | AdobeStock
Possible malignant diseases that can lead to a blockage or compression of the bile ducts include
Another indication for performing a PTC are so-called leakages of the biliary system. These can occur after liver surgery, Whipple surgery or a liver transplant, for example.
Under certain circumstances, PTC is not possible. These include severe coagulation disorders and pronounced ascites (accumulation of fluid in the free abdominal cavity).
A PTC is always performed on an inpatient basis. On the evening before the examination, the doctor provides the patient with comprehensive information about the examination and the necessary preparations.
Medication that inhibits blood clotting must be discontinued in advance. Extensive blood tests and sometimes extensive preliminary examinations may be necessary before the PTC.
The medical team first creates sterile conditions. This includes disinfecting the patient's skin. A local anaesthetic is then applied to the skin and liver capsule in the area of the right flank or upper abdomen.
A thin hollow needle is then inserted through the skin into the bile duct system under radiological and/or sonographic control. An X-ray contrast medium is then injected into the bile ducts via this hollow needle, which enables the bile duct system to be visualized in the X-ray image. The aim is to clearly visualize the bile duct system.
A soft wire is then inserted into the bile ducts via the hollow needle, through which a drainage tube is inserted. This drainage tube (PTCD) is used to drain the accumulated bile outwards (or inwards if necessary).
It is also possible to place a stent in the bile duct system via this access, which keeps constrictions or obstructions open. The stent restores the bile drainage pathway.
PTC is a safe procedure. It has relatively low complication rates and an overall mortality rate of around 1.7 percent.
However, as the complication rates for ERCP are even lower than for PTC, ERCP is usually performed in the presence of a bile blockage, if this is possible.
Possible complications that can occur in rare cases with PTC include
Complications such as bleeding may require further therapeutic measures such as
may be necessary.
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