Percutaneous transhepatic cholangiography (PTC)

A percutaneous transhepatic cholangiography (per-kew-tay-nee-us trans-hep-attic col-an-jee-og-raf-ee) is a way of looking at your bile ducts using x-rays. This test is also called PTC. 

Your doctor puts a long thin needle through the skin and into your liver and bile ducts. They take x-rays of the pancreas, gallbladder and bile ducts. They can also take samples (biopsies) of any abnormal looking areas.

You usually have a PTC if you can't have an ERCP for any reason or if you have had an ERCP but it didn’t work. For example, if doctors weren’t able to take samples of tissue or drain the bile ducts.

Why you might have a PTC?

A PTC helps your doctor find out what might be causing your symptoms. You might have this test if your doctor thinks there is a blockage in your bile ducts. A blockage in the bile ducts can cause:

• yellowing of your skin and whites of your eyes
• itchy skin
• tummy (abdominal) pain
• dark coloured urine 

If tests show that you have a blockage in your bile ducts, you might have treatment during a PCT to help relieve the blockage. This might include:

• drainage of the bile ducts
• putting a plastic or metal tube (stent) into the bile duct

Preparing for a PTC

Before the PTC you usually have a blood test to check how well your blood clots. Let the x-ray department know if you're taking medicines to thin your blood. These medicines include:

• aspirin
• clopidogrel
• arthritis medicines
• warfarin (Coumadin)

You might need to stop taking these medicines a number of days before the PTC. Your doctor or nurse will tell you when you should stop.

You can't eat for 6 to 8 hours before the test. You might be allowed to drink sips of water up to 2 hours before. Your appointment letter will give more detail about this and give you a number to ring if you have any questions.

Most people stay in hospital for at least one night after a PTC test. But some people can go home on the same day. 

Because you have sedation during the test to make you drowsy, you will need someone with you to take you home and stay overnight if you go home on the same day. You shouldn’t drive, drink alcohol, operate heavy machinery or sign any legally binding documents for 24 hours.

How you have a PTC

Just before the test

You have the test in the x-ray department. A specialist doctor called an interventional radiologist carries out the test. A radiographer and a nurse will also be in the room to help.

You change into a hospital gown and lie down on the x-ray couch. Your doctor puts a small tube (cannula) into your arm or the back of your hand. They use this to give you a drug to make you sleepy (sedation) and painkillers. You also have antibiotics as a tablet or injection to prevent infection.

Your nurse checks your blood pressure, heart rate and oxygen levels regularly during the test.

During the test

Your doctor cleans your tummy (abdomen) and injects a local anaesthetic into your skin. This numbs the area near the liver.

They put a long thin needle through the skin and into the liver and bile ducts. They use ultrasound or x-rays to help guide the needle. You may feel some discomfort when the needle goes into the liver. Tell your doctor or nurse if you have any pain.

The x-ray camera is above you but it doesn’t touch you. Your doctor injects some dye (contrast medium) into the bile ducts. You may have a warm sensation through your body. This is normal. The dye shows up on the x-rays, so the doctor can see where the blockage is.

Your doctor can take samples of cells from the bile ducts using a brush (brush cytology). And they may also take samples of tissue (biopsies). They send these samples to the laboratory for examination under a microscope.

They may put a drain or a tube called a stent into the bile duct to relieve a blockage.

After the test

You go back to the ward after the test. You may feel sleepy and might not remember much about the test.

You need to stay lying down for about 6 hours. This is to prevent bleeding. Your nurse will check your blood pressure, heart rate and temperature regularly to make sure there are no problems. You might have fluids through a drip.

You usually stay in hospital overnight. Your nurse will tell you who to contact if you have any problems when you’re at home. 

You may need to continue to take antibiotics for a couple of days after you go home. Your pharmacist or nurse will tell you for how long you need to take antibiotics. 

Possible risks

There are possible risks with a PTC. Some can be serious and life threatening. Your doctor makes sure the benefits of the test outweigh these risks.

Bruising and bleeding

You may have some bleeding which usually stops on its own. In some cases, this can be severe and you will need medicine to stop it and maybe a blood transfusion. 

Infection

There's a risk of infection with this test. If you get a temperature or generally feel unwell contact your doctor. 

Inflammation of the pancreas (pancreatitis)

You might have mild inflammation of the pancreas. This can cause pain in your tummy (abdomen). Your doctor can give you painkillers to help control this. It's important to tell your nurse or doctor if you get pain in your abdomen. 

Inflammation of the pancreas can also be severe. You might need to stay in hospital for some days if this happens.

Allergic reaction

There is a risk of having an allergic reaction to the sedation or dye. This can cause problems with your breathing, heart rate and blood pressure. If this happens, the staff will give you medicines to control the reaction. 

Exposure to radiation

The amount of radiation you receive from the x-rays during the test is small and doesn't make you feel unwell. Talk to your doctor if this worries you.

When to contact a doctor

Contact the hospital where you had the PTC or go the accident and emergency department (A&E) if you have:

• swelling or redness around the needle site
• pain in your abdomen or shoulder
• a high temperature
• signs of bleeding, including black or red poo (stools)

Getting your results

You should get your results within 1 or 2 weeks. 

Waiting for results can make you anxious. Ask your doctor or nurse how long it will take to get them. Contact the doctor who arranged the test if you haven’t heard anything after a couple of weeks.

You might have contact details for a specialist nurse who you can contact for information if you need to. It may help to talk to a close friend or relative about how you feel. You may want them to go with you to get the results for support.