What you need to know about:

Percutaneous Transhepatic Biliary Drainage (PTBD)

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Overview of

Percutaneous Transhepatic Biliary Drainage (PTBD)

in Thailand

Percutaneous Transhepatic Biliary Drainage (PTBD) is a medical procedure for diagnosis or treatment of a bile duct obstruction. The objective of the procedure is to locate the obstruction and/or to insert a temporary catheter to drain the bile. This is an option for patients who would like to avoid surgery or for whom surgery would be too risky as this procedure has fewer side effects than surgery. If the bile duct(s) gets blocked, the bile cannot drain normally and gets collected before to the site of the blockage. The signs of blocked bile ducts are jaundice (yellowing of the skin and white of the eye), dark urine, light- or clay-colored stools, itching, nausea, and loss of appetite. This condition is potentially serious and needs to be treated.

Goals of

Percutaneous Transhepatic Biliary Drainage (PTBD)

The common indication for percutaneous biliary drainage (PBD) is blockage or abnormal narrowing (stricture) of the bile ducts. Hoever, this procedure may be used to treat other conditions as well such as: Gallstones (stones in the gallbladder or within the bile ducts) Tumors of the bile ducts, liver, gallbladder or pancreas Pancreatitis (inflammation of the pancreas) Sclerosing cholangitis (a type of inflammation of the bile ducts) Enlarged lymph nodes in the region of the liver and pancreas Postoperative strictures (narrowing of the bile ducts or perforation due to injury to the bile ducts during surgery) Perforation Infection

Price of

Percutaneous Transhepatic Biliary Drainage (PTBD)

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Pros and cons of

Percutaneous Transhepatic Biliary Drainage (PTBD)

Pros

-If you are suffering symptoms of a blocked bile duct, such as skin discolouration, itching, nausea and tiredness, a biliary drainage may relieve some of these symptoms over time (it often takes a number of days after the procedure for these benefits to become apparent).

-Biliary drainage often improves the liver function tests in patients requiring chemotherapy as part of cancer treatment.

-If the bile in the blocked bile ducts is infected, biliary drainage is an important part of the treatment.  

Cons

-THe procedure is considered invasive so it will come with some risks such as bleeding, bile leaking and infection of the skin at the insertion site

How it works:

Percutaneous Transhepatic Biliary Drainage (PTBD)

In percutaneous transhepatic biliary drainage a small, flexible, plastic tube is placed through the skin into the liver to drain a blocked bile duct system. Ultrasound and x-ray of the abdomen locate the blockage of bile flow. Thereafter, the images made by ultrasound guide the placement of small plastic or metal tube (stent) in the liver to drain bile. The bile drains via the stent into the small bowel or in a collection bag outside the body. This procedure may relieve the obstruction symptoms before surgery is done. THe procedure usually lasts between 60 - 90 minutes

Preparation before

Percutaneous Transhepatic Biliary Drainage (PTBD)

Pre - treatment

Your healthcare provider will tell you how to prepare for the procedure. He or she may tell you not to eat or drink anything after midnight before the procedure. You may need to follow a certain diet before your procedure. You may need to see a dietitian who will teach you which foods to eat and which foods to avoid. If you drink alcohol, you may need to stop. You will discuss with your provider about all medicines you currently take. He or she will tell you if you need to stop any medicine for the procedure, and when to stop. He or she will tell you which medicines to take or not take on the day of the procedure. You may need to have blood tests and an EKG. You also may need x-rays, an ultrasound, a CT scan, or an MRI. You may be given antibiotics to help prevent a bacterial infection. Tell your provider if you had an allergic reaction to an antibiotic. You may have endoscopic retrograde cholangiopancreatography (ERCP) before your procedure. ERCP can help your provider plan your procedure. He or she may also remove stones or growths in your bile duct. Puncturing the bile duct is usually performed under sedation and local anaesthesia, though in rare cases and depending on the patient’s underlying condition and age, the procedure may be carried out under general anaesthesia.

Recovery after

Percutaneous Transhepatic Biliary Drainage (PTBD)

Post - treatment

You will be taken back to your ward where your blood pressure, pulse rate, oxygen levels and temperature are monitored regularly. You will be on best rest for a few hours until you have recovered. It is important to take care of the drainage bag so that the catheter does not get pulled out. The nurses will empty the drainage bag at regular intervals and record the drainage output. If you are discharged with the catheter and bag in place, the nursing staff will teach you how to care for the catheter at home, such as how to empty the bag and change the dressing.  You will probably need to keep the catheter for two to three weeks or until bile flows into the intestines normally. This depends on the doctor’s treatment plan. If this procedure is part of palliative care, you may have to keep the catheter for the rest of their life.

Risks & side effects

-Intra-abdominal bleeding; bleeding in the bile duct.  

-Infection of the skin where the catheter is inserted and infection in the bile duct.  

-Allergic reaction to contrast media during the procedure.  

-Catheter dislodgement.  

-Bile leakage.

FAQs:

Percutaneous Transhepatic Biliary Drainage (PTBD)

How do I care for my catheter at home after the procedure?

Please care for your catheter as follows:  1. Notice the appearance of the bile, such as the color and concentration, and record the amount of bile released each day. 2. Notice the position and appearance of the catheter to ensure it is not broken, folded, bent or caught on something. 3. You should see your doctor immediately if: - The catheter has been dislodged or moved more than five centimeters. - Bile leaks through the bandage or the bandage has moved or fallen off. - No Bile flows within 24 hours or less than usual. - You have a high fever. 4. You can take a bath normally. Avoid getting your wound wet or dirty. If your bandage becomes wet enough that it soaks to the gauze below, clean the wound after bathing and place a new bandage on it. Do not soak in water or swim while the catheter is attached. 5. Clean your wound twice a week or as needed. Follow these instructions - Wash your hands with soap two to three times and wipes them dry with a clean cloth before changing the dressing. - Use a clean cotton ball soaked in a Beta dine solution to wipe around the wound and the catheter attached to the skin. Since the catheter moves in and out as you breathe, use a cotton ball soaked in a 70% alcohol solution to clean the same area again. - Cover the wound with sterile gauze, and then place a bandage over the catheter to attach it to your abdomen to prevent it from being bent. - Use a bandage to attach the catheter to your abdomen to keep it in place. 6. Come in to the hospital to change your collecting bag every month or as recommended by your doctor.

What are the recommendations for travel after the procedure?

After you are discharged, it is recommended that you stay at a hotel close to the hospital for at least two days for convenience in traveling to the hospital if any complications arise after the procedure.

What are the contraindications for this procedure?

Some patients with obstruction in the bile duct system may not be eligible for the percutaneous transhepatic biliary drainage (PTBD) for several reasons, such as prolong coagulation, sepsis, massive ascites, cancer that has spread to the liver and multiple blockages in the bile duct system. This group of patients may have to consider alternative procedures to alleviate their symptoms.

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