PTBD is one of the most essential procedures in cases with dilated IHBR due to failed ERCP stenting, blocked CBD stent, Distal CBD lesion with stenting not possible and in cases with non dilated system with CBD injury.

If meticulously performed, this procedure is technically feasible in all cases with good success rate.

It gives immediate sympomatic relief as well as brings down the levels of bilirubin down.

Once bilary system edema subsides, internalisation of PTBD drainage cather followed by PTBD guided biliary stenting is possible.