What is PTBD & Biliary Stenting?
Percutaneous Transhepatic Biliary Drainage (PTBD) and Biliary Stenting are procedures in which a fine needle is passed through the skin and liver under imaging guidance to access the bile ducts. A catheter is placed to drain bile that has backed up due to a blockage caused by a tumour, stone, or stricture relieving jaundice, painful itching, and life-threatening cholangitis. In the same or a subsequent session, a self-expanding metallic stent can be deployed across the obstruction to permanently reopen the bile duct and restore internal bile flow eliminating the need for an external drainage bag.
Who is this procedure for?
These procedures are indicated for patients with obstructive jaundice caused by malignant biliary obstruction (pancreatic cancer, cholangiocarcinoma, gallbladder cancer, liver metastases) or benign strictures (post-surgical anastomotic strictures, inflammatory conditions) where endoscopic access via ERCP has failed or is not anatomically possible. PTBD is also performed urgently to decompress infected bile (acute cholangitis) in critically unwell patients before definitive treatment.
How is the procedure performed?
- Ultrasound and fluoroscopy are used to guide needle insertion through the skin and liver parenchyma into a dilated intrahepatic bile duct.
- Contrast is injected to outline the entire biliary system (percutaneous cholangiogram) and identify the level and extent of obstruction.
- A guidewire is carefully manoeuvred across the stricture or block and advanced into the duodenum.
- An external drainage catheter is placed initially to decompress the biliary system and allow jaundice to resolve over 3–5 days.
- Once the tract has matured, the catheter is exchanged over the guidewire for a self-expanding metallic stent placed precisely across the obstruction.
- After confirming satisfactory stent deployment and internal bile flow on fluoroscopy, the external catheter is removed and the patient is discharged.
