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PTBD Percutaneous Biliary Drainage In Mumbai
Minimally Invasive Relief of Obstructive Jaundice Without Open Surgery
PTBD (Percutaneous Transhepatic Biliary Drainage) is a minimally invasive interventional radiology procedure that relieves obstructive jaundice by inserting a thin drainage catheter through the liver skin into the bile ducts under X-ray and ultrasound guidance, bypassing an obstruction and draining bile externally or internally.
At Shree Hospitals, our specialist interventional radiologists perform PTBD for patients with biliary obstruction caused by bile duct cancer (cholangiocarcinoma), pancreatic cancer, gallstones, bile duct strictures, or post-surgical complications, rapidly relieving jaundice and protecting liver function.
Obstructive Jaundice? Ask Our Interventional Radiology Team About PTBD
Quick facts
Procedure Type : Percutaneous Transhepatic Biliary Drainage (External or Internal-External)
Anaesthesia : Conscious Sedation and Local Anaesthesia
Duration : 45 to 90 minutes
Hospital Stay : 2 to 3 days
Recovery Time : Jaundice improves within 24 to 48 hours of drainage
Support Team : Interventional radiologists, hepatologists, gastroenterologists, oncologists
Key Benefit : Rapidly relieves jaundice, protects liver function, avoids surgical bypass
What is PTBD (Percutaneous Transhepatic Biliary Drainage)?
Obstructive jaundice occurs when the bile ducts - the channels carrying bile from the liver to the small intestine - are blocked, preventing bile from draining normally. Bile builds up in the liver and bloodstream, causing the characteristic yellowing of the skin and eyes (jaundice), dark urine, pale stools, severe itching (pruritus), and progressively deteriorating liver function. If untreated, biliary obstruction leads to cholangitis (bile duct infection), liver failure, and coagulopathy (clotting failure). PTBD provides an urgent, life-saving bypass of the obstruction.
In PTBD, the interventional radiologist uses ultrasound to guide a fine needle through the skin and liver tissue directly into the dilated intrahepatic bile ducts. Contrast dye is injected to visualise the biliary system on X-ray (fluoroscopy) and identify the precise site and nature of the obstruction. A guidewire is passed through the obstruction (or positioned above it) and a drainage catheter is inserted to allow bile to drain either into an external bag (external drain) or through the obstruction back into the bowel (internal-external drain). A biliary stent can also be placed across the obstruction to provide long-term internal drainage without an external bag.
At Shree Hospitals, PTBD is available as an emergency procedure for patients with acute biliary obstruction, septic cholangitis, or rapidly deteriorating liver function. Our interventional radiology team works in close coordination with hepatology, gastroenterology, oncology, and hepatopancreato-biliary (HPB) surgery to manage the underlying cause of obstruction while providing immediate biliary decompression. Where ERCP (endoscopic) drainage has been attempted and failed, or is not technically feasible, PTBD provides a reliable alternative route of biliary access.
Who Is a Candidate for PTBD?
PTBD is indicated for patients with biliary obstruction caused by:
- Pancreatic cancer or ampullary cancer obstructing the common bile duct
- Cholangiocarcinoma (bile duct cancer) causing hilar or intrahepatic ductal obstruction
- Gallstones in the bile duct causing obstruction when ERCP has failed or is not technically possible
- Post-surgical bile duct strictures after cholecystectomy, liver surgery, or liver transplantation
- Post-liver transplant biliary complications including anastomotic strictures or bile leaks
- Acute cholangitis (infected bile duct) requiring emergency biliary decompression
Is PTBD the Right Approach for Biliary Drainage?
PTBD is recommended when:
- ERCP (endoscopic biliary drainage) has been unsuccessful or is not technically possible (post-surgical anatomy, inaccessible papilla)
- Hilar biliary obstruction affecting both left and right hepatic ducts requires selective ductal drainage
- Urgent biliary decompression is needed and ERCP is not immediately available or has failed
- Biliary stenting via the percutaneous route is planned for long-term internal drainage
- The patient's liver function is deteriorating rapidly from biliary obstruction and urgent decompression is required
Why Relieving Biliary Obstruction Urgently Is Critical?
Untreated biliary obstruction rapidly causes life-threatening complications:
- Cholangitis (ascending biliary infection) causes fever, rigors, hypotension, and septic shock if drainage is delayed
- Progressive liver failure from bile accumulation in liver cells causes coagulopathy and encephalopathy
- Malnutrition from impaired bile flow into the intestine affecting fat digestion
- Severe pruritus (itching) from bile salts in the bloodstream causes extreme distress
- PTBD provides immediate biliary decompression, reversing jaundice and preventing irreversible liver damage before definitive oncological or surgical treatment
PTBD achieves successful biliary decompression in over 90% of cases, with jaundice improvement within 24 to 48 hours of drain placement.
At Shree Hospitals, our interventional radiology team performs emergency PTBD 24 hours a day, rapidly relieving obstructive jaundice and protecting liver function while the underlying cause is investigated and definitive treatment planned.
24×7 Emergency Care
Our Approach to PTBD
At Shree Hospitals, PTBD is performed as an urgent or emergency procedure when clinically required, with our interventional radiology team available around the clock. Every case is managed in close collaboration with the referring gastroenterology, hepatology, oncology, or surgical team to ensure the biliary drainage strategy is coordinated with the overall management plan.
24×7 Emergency Care
Urgent Clinical Review and Imaging Assessment
On referral, our interventional radiologist reviews the patient's clinical status, liver function tests (bilirubin, ALT, ALP), clotting profile, and most recent abdominal ultrasound or CT cholangiogram. The level and cause of the obstruction, degree of biliary dilatation, and the anatomy of the biliary system are assessed. The optimal ductal entry point and access route are planned. Where cholangitis is present, urgent decompression is prioritised.
Ultrasound-Guided Transhepatic Duct Access
Under real-time ultrasound guidance, a fine needle is advanced through the right (or left) lobe of the liver to puncture a dilated intrahepatic bile duct. Contrast injection under fluoroscopy (a percutaneous cholangiogram) maps the biliary anatomy, confirms the site and nature of the obstruction, and demonstrates whether the obstruction can be crossed with a guidewire. Access to the bile duct is confirmed before the drainage catheter is inserted.
External, Internal-External, or Stent Drainage
Based on the clinical situation, one of three drainage strategies is chosen. External drainage (bile drains into an external bag) is used for emergency decompression, infected bile (cholangitis), or when the obstruction cannot be crossed. Internal-external drainage (bile drains both externally and internally into the bowel) is used once the obstruction is crossed, providing physiological bile flow while maintaining external access. Metallic biliary stents are placed percutaneously for long-term internal drainage in patients with malignant obstruction.
Drain Care and Definitive Treatment Planning
After PTBD, the biliary drain is flushed daily and bile output is monitored. Liver function tests are checked regularly to confirm jaundice resolution. The drain is managed by our nursing team in coordination with the clinical team. Once bilirubin levels have fallen adequately, definitive treatment (surgery, chemotherapy, or biliary stenting) is planned. For patients with malignant obstruction, metallic stent placement converts the external drain to internal drainage, removing the need for an external bag.
Interventional Radiology Services
We offer a comprehensive range of minimally invasive interventional radiology procedures including PTBD, percutaneous drainage, TACE, RFA, UAE, peripheral angioplasty, vertebroplasty, and IVC filter placement, all delivered by specialist interventional radiologists using advanced imaging guidance.
Interventional Radiologists and Hepatobiliary Specialists in Mumbai
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10+ years of experience
Dr. Swati Narurkar
Interventional Radiology
Step by Step Process of PTBD
Step 1 - Urgent Referral and Clinical Assessment
On receipt of an urgent referral, our interventional radiologist reviews the patient's clinical status, jaundice severity (bilirubin level), signs of cholangitis (fever, rigors, hypotension), and the most recent abdominal imaging. Blood tests including full blood count, clotting profile, liver function, and blood cultures (if infection is suspected) are reviewed. The need for urgent decompression vs elective scheduling is determined. Intravenous antibiotics are administered for suspected cholangitis before the procedure.
Step 2 - Patient Preparation
Coagulopathy (prolonged clotting) is corrected with vitamin K, fresh frozen plasma, or platelets as needed to reduce bleeding risk. Intravenous fluids and antibiotics are given. Conscious sedation is administered along with local anaesthesia at the access site. The patient is positioned for right-sided (or left-sided) biliary access based on imaging anatomy.
Step 3 - Ultrasound-Guided Bile Duct Puncture
Under real-time ultrasound guidance, a 22-gauge Chiba needle is advanced through the right lower intercostal space into the liver to puncture a peripheral dilated intrahepatic bile duct. Successful puncture is confirmed by aspiration of bile. Contrast dye is injected to perform a percutaneous cholangiogram - a detailed X-ray map of the biliary system identifying the obstruction site, biliary anatomy, and intrahepatic ductal dilatation.
Step 4 - Guidewire Passage and Track Dilatation
A guidewire is passed through the needle into the bile duct and advanced through or above the obstruction. The needle is exchanged for progressively larger dilators to create a tract through the liver parenchyma sufficient to accommodate the drainage catheter. The tract is dilated step by step to the required catheter size (typically 8 to 10 French).
Step 5 - Drainage Catheter or Stent Placement
A pigtail drainage catheter (for external or internal-external drainage) or a metallic biliary stent (for long-term internal drainage) is inserted over the guidewire into the desired position. Correct positioning - with side holes above and below the obstruction for internal-external drains, or across the obstruction for stents - is confirmed on fluoroscopy. Bile flow through the catheter confirms successful drainage. The catheter is secured to the skin.
Step 6 - Post-Procedure Monitoring and Jaundice Resolution
The patient is monitored for 24 to 48 hours for bleeding, bile leak, and procedure-related fever. Bile output from the drain is recorded and fluid replacement given as needed. Liver function tests are monitored daily - bilirubin typically begins to fall within 24 to 48 hours and normalises over 1 to 2 weeks. The drain is flushed regularly. A follow-up cholangiogram at 48 to 72 hours confirms adequate drainage before planning the next steps in management.
Patient Questions About PTBD
How is PTBD different from ERCP for biliary drainage?
Both PTBD and ERCP (Endoscopic Retrograde Cholangiopancreatography) drain bile ducts but use different routes. ERCP approaches the bile duct from the inside via an endoscope passed through the mouth into the duodenum. PTBD approaches from the outside via a needle through the skin and liver. ERCP is generally preferred for bile duct stones and lower biliary obstructions where the endoscope can reach the bile duct opening. PTBD is preferred when ERCP has failed, is technically not possible (post-surgical anatomy, duodenal obstruction), or when the obstruction is at the liver hilum (junction of left and right bile ducts) which can be difficult to drain endoscopically.
Will I have an external bag after PTBD?
This depends on the type of drain placed. External drainage requires an external bag to collect bile and is used for emergency situations, cholangitis, or when the obstruction cannot be crossed. Internal-external drainage crosses the obstruction and allows bile to flow both into the external bag and naturally into the bowel - the bag can be capped once the patient is stable, allowing fully internal drainage. Metallic biliary stent placement removes the need for any external bag permanently, providing internal drainage across the obstruction. Our team aims to convert every patient to internal drainage as soon as it is safely possible.
Is PTBD safe for patients with cancer?
Yes. PTBD is specifically designed for and commonly performed in patients with malignant biliary obstruction from pancreatic cancer, cholangiocarcinoma, or liver metastases. It is a well-established, safe procedure in this setting. For cancer patients, PTBD or biliary stenting is used to relieve jaundice before chemotherapy (which cannot be given safely with high bilirubin) or before planned surgery (Whipple's procedure). Metallic stents placed percutaneously provide durable long-term drainage for patients with inoperable malignant obstruction.
Can PTBD be performed if my clotting is abnormal from jaundice?
Jaundice reduces the liver's production of clotting factors, causing coagulopathy that must be corrected before PTBD to minimise bleeding risk. Our team administers intravenous Vitamin K (which helps the liver produce clotting factors), fresh frozen plasma, and platelets as needed to correct the clotting profile before the procedure. Most patients with jaundice-related coagulopathy can have PTBD performed safely after pre-procedure correction. Our interventional radiology team assesses each patient individually and only proceeds once the clotting risk is at an acceptable level.
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