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Percutaneous Transhepactic Cholangiogram (PTC)

Overview

PTC 1(copy)(copy)A Percutaneous Cholangiography (PTC) is a test, using x-ray, that shows whether the liver or the bile ducts (the tubes that carry bile from the liver to the gallbladder and small intestines) are blocked. Contrast material (dye) is injected directly into the liver's drainage system. The dye should then spread throughout the entire drainage system and be visible on x-ray. Where this does not happen, it means there must be a blockage.












 

What is a PTC?

A Percutaneous Transhepatic Cholangiogram (PTC) - also known as Percutaneous Cholangiography - is an x-ray test that can show whether there are blockages in the liver or the bile ducts that drain it.

Since the liver and its drainage system do not normally show up on x-ray, contrast media (x-ray dye) is injected directly into the drainage system of the liver. This dye, which is visible on x-rays, should then spread out to fill the whole drainage system. If it does not, that means there is blockage.
PTC 2
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Why do I need a PTC?

This test can help diagnose the cause of a bile duct blockage. Bile is a liquid released by the liver. It contains cholesterol, bile salts, and waste products. Bile salts help your body break down (digest) fats. A blockage of the bile duct can lead to swelling of the gallbladder or pancreas.

A diagnostic PTC is also performed when other less invasive methods of imaging the biliary tree (e.g. MR imaging, MRCP [Magnetic resonance cholangiopancreatography], ERCP [Endoscopic retrograde cholangiopancreatography], CT imaging) have proven unsatisfactory. Some of the reasons a PTC is carried out are:
  • a failed ERCP procedure;
  • an ERCP is not feasible (e.g. patients with gastrojejunostomy);
  • the biliary system cannot be clearly seen / outlined due to gallstones;
  • to identify any obstructive causes of liver jaundice and differentiate from medically treatable causes;
  • to review anatomic complications of ERCP; and / or
  • to identify and outline any bile leaks.
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How is a PTC performed?

The procedure will be conducted in an angiography suite (“cath lab”) at Mercy Angiography, which is in the Mercy Hospital at 98 Mountain Road, Epsom in Auckland. Your interventional radiologist will be assisted by nurses and other highly trained staff. 

You will be awake during the procedure but lightly sedated. You will be asked to lie on your back on the x-ray table. The upper right-hand side of your belly area will be cleaned and numbing medication is applied. An Intravenous catheter (IV line) for administration of fluids and medication will be inserted into a vein on the back of your hand or in your arm.

A long two-part needle (approx. 15cm) is used for the procedure and the point of entry for the needle is usually determined using ultrasound guidance.  The needle is inserted into one of the peripheral ducts.  A small amount of contrast media / x-ray dye is injected, to enable your specialist visualise the needle placement using Fluoroscopy (x-ray). The needle placement is adjusted until it is clear that the dye is flowing easily through the ducts (drainage tubes) inside your liver.

Once satisfactory position of the needle is confirmed, the needle is replaced with a softer plastic tube. Adequate amount of x-ray dye is injected through the plastic tube and various projections of the biliary tree are obtained to evaluate the obstructive pathology.

You will feel some discomfort as the needle is advanced into the liver and may be given medication for pain control if necessary. Generally, the x-ray itself causes little or no discomfort.

X-ray images during a PTC show the following:

PTC Fluoro 1
PTC Fluoro 2(copy)


















 
PTC Fluoro 3(copy)
 
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How should I prepare for my procedure?

  • Fasting: You may eat until 2 hours before admission then you should not have anything to  eat. You may continue to drink clear fluids.
  • Allergies or previous reactions to contrast (x-ray dye): Please inform Mercy Angiography staff at the time of booking your procedure if you have any known history of allergies, particularly allergies to x-ray contrast and seafood.
  • Diabetes: If you are a diabetic you should tell the Mercy Angiography staff at the time of booking. You may need to discuss your insulin dose with your cardiologist.
  • Warfarin or Coumadin: If you are taking Warfarin (a “blood thinner”) you should make this known to Mercy Angiography staff at the time of booking. It is likely that you will need to stop this medication temporarily for a few days before angiography.
  • Other usual medications: Continue these unless advised otherwise by your cardiologist. In particular, please continue taking your aspirin. 

Please bring with you any medication and any recent blood test results or chest x-rays. 

You may bring a favourite music CD as this can be played during the procedure.

You are encouraged to bring a friend or family member.

On the day of your procedure, please make your way to the Mercy Hospital Reception where they will be expecting you. You will be admitted to a hospital ward and transferred to Mercy Angiography for your procedure.


For directions to the Mercy Hospital, click here.
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What happens after my procedure?

  • The catheter or needle is removed and a pressure bandage is applied to the area.
  • If there is a blockage, a drainage tube is put in place. If a stent is is put in place then a pressure bandage is applied.
  • Your interventional radiologist will discuss the findings with you following your procedure or at a follow-up appointment.
You should be discharged shortly after the procedure if there are no complications during / after procedure.
 
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What are the risks?

  • There is a very slight risk of an allergic reaction to contrast media / x-ray dye. 
  • It is possible to have serious bleeding from this test. In some cases, blood leaks to the outside surface of the liver and causes a build-up of blood there.
  • Bruising or bleeding at the puncture site, and infection.
  • There is always a slight chance of cancer from excessive exposure to radiation from the x-rays. However, the benefit of accurate diagnosis far outweighs the risks.
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