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 provides immediate relief from symptoms like jaundice, pruritus, and pain while reducing the risk of cholangitis and liver damage from backed-up bile 1. A meta-analysis comparing percutaneous versus endoscopic biliary drainage demonstrated no significant difference with regards to mortality, complications, or therapeutic response rates, making percutaneous biliary drainage a validated second-line therapy in these patients 1.
From the Research
Procedure to Drain Bile Outside the Body
The procedure to drain bile outside the body is known as biliary drainage. There are two main types of biliary drainage:
- Percutaneous transhepatic biliary drainage (PTBD)
- Endoscopic biliary drainage (EBD)
When is the Procedure Done
The procedure is done in the following situations:
- Malignant obstructive jaundice: PTBD and EBD are used to palliate jaundice and pruritus, and to manage cholangitis 2, 3, 4, 5, 6
- Obstructive jaundice caused by hepatocellular carcinoma: Biliary drainage can improve clinical outcome and survival in patients with obstructive jaundice caused by hepatocellular carcinoma 6
- Benign obstructive jaundice: PTBD can be used to decompress the obstructed biliary tract and palliate jaundice and pruritus 4
Key Considerations
Some key considerations when choosing between PTBD and EBD include: