What Is a Percutaneous Transhepatic Cholangiogram?
Percutaneous transhepatic cholangiogram (PTCA) is a radiologic procedure used to pinpoint bile duct blockages in your liver.
A local anesthetic and medications are given to make you sleepy and relaxed before the procedure. The doctor then inserts a long, flexible needle into your liver, using X-rays to guide the path. Once the needle has reached your liver, the doctor injects a dye that makes it possible to see the bile ducts on X-ray.
The test is considered normal if the ducts appear to be of normal size and the dye flows smoothly. You are diagnosed as having a problem with your bile duct system if the ducts are much narrower or wider than they should be; or, if there is a duct where the dye is trapped and cannot flow.
What Is Bile?
Bile is a fluid substance released by the liver through a series of ducts or small hollow tubes. Bile helps the body digest fat. If it becomes trapped in the ducts, it can become infected. You may experience swelling and pain in your abdomen and notice that you are running a fever.
If your ducts are blocked, you have too much of a substance called bilirubin in your system. This causes jaundice, a condition that makes your skin and eyes look yellowish. You may also notice that your skin itches.
All of these symptoms indicate that there may be a problem with your bile ducts.
When Is PTCA Performed?
PTCA is performed if:
- you show symptoms of a blockage in your bile ducts, such as fever, abdominal pain, and yellowing of skin and eyes
- you cannot undergo a procedure called endoscopic retrograde cholangiopancreatography (ERCT)
- ERCT is not available at your diagnostic facility
Doctors prefer to use ERCT because:
- patients report less discomfort
- ERCT can be used to treat a blockage and identify it
- ERCT has fewer side effects than PTCA
- PTCA cannot provide images of the pancreas while ERCT can
ERCT, however, is not right for every patient. It is not a good choice, for instance, for people with a history of surgery that alters that anatomy of the abdomen (for instance, someone who has undergone gastric bypass surgery).
PTCA is used on patients who have abnormalities of the esophagus or small intestine. If doctors cannot get the images they need using ERCT, they turn to PTCA for help.
How Is PTCA Performed?
You will be instructed not to eat or drink anything for six to eight hours prior to your exam. Be sure to tell your healthcare provider if you are pregnant. Also, be sure to tell your healthcare provider about any medications you are taking, especially blood thinners such as warfarin or Plavix.
PTCA is performed in a radiology department. When you have checked in, a technician will give you a hospital gown to wear in place of your clothing. You should also remove any jewelry.
You will then lie on your back on the X-ray table. A nurse will insert an IV into your hand, wrist, or arm and cleanse the area over your right ribcage with antiseptic. Your doctor will then give you an injection of medication that makes you sleepy. This will ensure that you doze through the procedure and are not bothered by any discomfort.
As the sedative starts to take effect, the doctor will inject medicine into the skin over your right ribcage to numb the area. When the skin is numb, your doctor will use guidance provided by X-rays to insert a long, thin needle between two of your ribs and into your liver. Once the needle is in your liver, the doctor will inject some dye that will flow into the bile ducts. The area is then X-rayed.
The test lasts about an hour. When you awake, a nurse will put a bandage or surgical dressing on the puncture wound and you will be released to go home after a couple of hours. However, doctors suggest that you spend at least the next eight hours resting and recuperating. You may feel out of sorts, tired, and sore for the next couple of days.
The most common complications of percutaneous transhepatic cholangiogram are bleeding and infection at the puncture site. In rare cases, the needle inserted into your liver damages another organ. These wounds are usually minor and heal themselves. Damage to a blood vessel is a rare but serious complication. It could lead to internal bleeding if not repaired.
Call your doctor right away if you notice heavy bleeding or discharge from the puncture site or if you experience abdominal pain or a temperature of over 100 degrees F.
A radiologist who then reports the findings to your doctor analyzes the test. It can take a few days to get your test results. When the radiologist looks at the tests, he or she will look for:
- unusually large ducts, which may mean fluid or bile is building up inside of them
- small ducts, which might prevent bile from flowing normally
- areas in the liver where the bile cannot pass through the duct at all
Although additional tests may be needed to discover exactly what is causing the blockage, researchers have discovered that direct cholangiography can predict with high accuracy whether the blockage is noncancerous or cancerous (Alam et al., 2007). This information saves doctors and patients time by allowing them to focus on the most appropriate form of follow-up.