What is the role of percutaneous transhepatic cholangiogram (PTC) in the workup of biliary obstruction?

Updated: Oct 16, 2019
  • Author: Jennifer Lynn Bonheur, MD; Chief Editor: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS  more...
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Answer

PTC is performed by a radiologist using fluoroscopic guidance. [10] The liver is punctured to enter the peripheral intrahepatic bile duct system. An iodine-based contrast medium is injected into the biliary system and flows through the ducts. Obstruction can be identified on the fluoroscopic monitor. It is especially useful for lesions proximal to the common hepatic duct.

The technique is not easy and requires considerable experience. More than 25% of attempts fail (most often when the ducts cannot be well visualized because they are not dilated, ie, not obstructed.)

Complications of this procedure include the possibility of allergic reaction to the contrast medium, peritonitis with possible intraperitoneal hemorrhage, sepsis, cholangitis, subphrenic abscess, and lung collapse. Severe complications occur in approximately 3% of cases.

The accuracy of PTC in elucidating the cause and site of obstructive jaundice is 90-100% for causes within the biliary tract. The biliary tree can be successfully visualized in 99% of patients with dilated bile ducts and in 40-90% if the bile ducts are not dilated. Still, ERCP is generally preferred, and PTC is reserved for use if ERCP fails or when altered anatomy precludes accessing the ampulla.


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