What procedure drains bile outside the body, specifically a biliary drainage (percutaneous transhepatic biliary drainage, PTBD), and when is it indicated?

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 normal flow of bile into the intestines is blocked due to gallstones, tumors, strictures, or inflammation 1. The indications for PTBD include:

• Blockages caused by gallstones
• Tumors, such as pancreatic cancer or cholangiocarcinoma
• Strictures
• Inflammation The procedure involves inserting a catheter through the skin and liver to create a pathway for bile to drain externally into a collection bag. This intervention is necessary when patients present with symptoms like:
• Jaundice
• Severe itching
• Infection (cholangitis)
• When preparing for surgery on the biliary system According to a meta-analysis comparing percutaneous versus endoscopic biliary drainage, there is no significant difference with regards to mortality, complications, or therapeutic response rates 1. Alternatively, percutaneous placement of self-expanding stents has demonstrated safety and effectiveness similar to their endoscopically placed counterparts 1. The drainage relieves pressure in the biliary system, reduces jaundice, prevents infection, and can serve as a temporary measure before definitive treatment or as palliative care in advanced malignancies.

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:

• Location of obstruction
• Purpose of drainage (preoperative procedure or palliative treatment)
• Level of experience in biliary drainage at individual treatment centers 2, 5
• Risk of complications, such as bleeding, pancreatitis, cholangitis, and tube dislocation 2, 5