PTBD Procedure in Lucknow

The bile ducts carry bile, a digestive fluid made in the liver, to the bowel. If a duct is blocked, bile backs up into the blood. The skin and eyes turn yellow, which is jaundice. Urine goes dark, stools turn pale and the skin itches.

PTBD stands for percutaneous transhepatic biliary drainage. Percutaneous means through the skin, transhepatic means through the liver, and biliary means the bile ducts. A needle enters a duct inside the liver, a wire and then a thin tube follow, and the tube is left in place. Bile drains into a bag, or past the blockage into the bowel.

Doctors consider PTBD when a bile duct is blocked and the blockage has to be relieved. The cause may be a tumour of the bile duct, gallbladder or pancreas, a stone or a narrowing called a stricture. Unblocking the duct eases the itching, lets the liver recover and is sometimes needed before chemotherapy or surgery. It is urgent when the trapped bile is infected, a condition called cholangitis. Yellow eyes with fever or shaking chills need medical care the same day, so go to an emergency department rather than waiting for a booking.

It is not the first choice for everyone. If the blockage can be reached with a telescope passed through the mouth, a procedure called ERCP, doctors often try that first. PTBD is often used when ERCP cannot be done, has not worked or does not suit where the blockage lies.

It may also be delayed or avoided in some situations. These include bile ducts that are not widened on a scan such as ultrasound, unsafe blood clotting and a lot of fluid in the belly. Your doctors correct what they can first.

The team at the centre reads your referral, scans and blood reports, and then confirms whether PTBD can be done here or elsewhere, and by whom. The team will tell you when you book.

In an external drain, all the bile flows out into a bag. In an internal-external drain, the tube crosses the blockage, so bile also flows into the bowel. Either way the tube is a bridge, not a cure. The cause of the blockage still needs its own treatment.

A drain that sends all the bile outside can leave you short of fluid and salts, so follow the team's advice on drinking and eating. Later, a stent, which is a small tube that stays inside the duct, can sometimes replace the outside drain. See biliary stenting.

PTBD is a significant procedure, and the people who need it are often already unwell. The main risks are:

• Infection of the bile ducts or the blood. Antibiotics are usually given around the procedure.
• Bleeding from a blood vessel in the liver, either inside the liver or into the bile.
• A bile leak into the belly, causing pain and inflammation.
• Injury to the lining of the lung or to nearby organs, because the needle passes close to them.
• Tube problems: blockage, kinking, slipping or leaking.

The drain cannot treat what caused the blockage, and in some people one tube cannot drain every duct. The team explains what to expect in your case before you consent.

You or a carer should be shown how to care for the tube and bag before you go home, so ask if this has not happened. Keep the dressing dry, secure the tube, empty the bag as shown, and note how much drains and what colour it is. The routine is similar to the care of a PCD drain, except that the bag collects bile. Flush only if the team has taught you how.

A PTBD tube does not last for ever. It is changed at intervals your doctors set, because it can clog. How long it stays depends on the cause and on the treatment that comes next. It can be weeks or months.

Itching often eases within days of bile flowing, while the yellow colour takes longer to fade. Blood tests, including liver tests from our pathology lab, show how the jaundice is falling, and your doctor repeats them.