From the Guidelines
Percutaneous transhepatic biliary drainage (PTBD) is the procedure of choice to drain bile outside the body when endoscopic biliary drainage is not feasible or has failed. This procedure is typically performed in cases of biliary obstruction, where the bile ducts are blocked and bile cannot flow normally into the intestines 1. The indications for PTBD include:
- Malignant biliary obstruction
- Benign biliary strictures
- Bile leaks
- Severe cholangitis that doesn't respond to antibiotics During PTBD, a thin needle is inserted through the skin into the liver to access the bile ducts, then a catheter is placed to drain bile into an external collection bag. The procedure is considered a validated second-line therapy, with no significant difference in mortality, complications, or therapeutic response rates compared to endoscopic biliary drainage 1. Alternatively, percutaneous placement of self-expanding stents has demonstrated safety and effectiveness similar to their endoscopically placed counterparts 1. Patients with external drainage need to empty their drainage bag regularly, monitor drainage color and amount, keep the insertion site clean, and watch for complications like fever, severe pain, or bleeding, which should prompt immediate medical attention.
From the Research
Procedure to Drain Bile Outside the Body
The procedure to drain bile outside the body is known as percutaneous transhepatic biliary drainage (PTBD) or endoscopic biliary drainage (EBD).
- PTBD involves the insertion of a catheter through the skin and into the liver to drain bile directly from the liver into a bag outside the body 2, 3.
- EBD involves the insertion of a tube through the mouth and into the small intestine to drain bile from the bile ducts into the intestine or outside the body 4, 5.
When is the Procedure Done
The procedure is typically done in patients with obstructive jaundice, which is a condition where the flow of bile from the liver to the small intestine is blocked, causing a buildup of bile in the blood and tissues.
- The procedure is often performed in patients with malignant obstructive jaundice, which is caused by cancer in the bile ducts or pancreas 4, 5.
- It is also performed in patients with benign obstructive jaundice, which is caused by non-cancerous blockages in the bile ducts, such as gallstones 3.
- The decision to perform PTBD or EBD depends on various factors, including the location and cause of the obstruction, the patient's overall health, and the availability of expertise and equipment 4, 5.
Indications for the Procedure
The indications for PTBD or EBD include:
- Obstructive jaundice caused by hepatocellular carcinoma 6
- Malignant obstructive jaundice caused by cancer in the bile ducts or pancreas 4, 5
- Benign obstructive jaundice caused by non-cancerous blockages in the bile ducts, such as gallstones 3
- Intractable symptoms, such as pruritus and cholangitis, caused by obstructive jaundice 3