Percutaneous transhepatic biliary drainage

Percutaneous transhepatic biliary drainage, also known as percutaneous transhepatic cholangial drainage (PTCD), is an interventional radiology procedure undertaken for those with biliary obstruction. 

It is commonly undertaken as part of palliative biliary stent insertion. Rarely, it is used in the treatment of benign strictures.

Indications

• malignant obstruction

  • cholangiocarcinoma

  • ampullary and pancreatic malignancies when retrograde access via endoscopic retrograde cholangiopancreatography (ERCP) is not amenable

• benign obstruction

  • iatrogenic strictures

    • previous anastomosis (e.g. post-liver transplant)

    • suture granuloma

    • diathermy burns

    • hemostasis clips

    • amputation neuroma of the cystic duct

  • primary sclerosing cholangitis

Precautions

If a stent is present in the biliary ducts, the drainage catheter should not be placed in the pigtail conformation as the small wire retaining the shape may get attached to the stent, preventing it's removal.