A GUIDE TO HAVING PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAM (PTC) AND BILIARY DRAIN/DILATATION/STENTING

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1 A GUIDE TO HAVING PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAM (PTC) AND BILIARY DRAIN/DILATATION/STENTING

2 WHAT IS PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAM (PTC) AND BILIARY DRAIN/ DILATATION/STENTING? A percutaneous transhepatic cholangiogram (PTC) is a procedure that uses X-rays to examine the bile ducts and drainage system in your liver. Bile ducts are tubes inside your liver that carry bile (a fluid that helps to break down fats when you digest food) from your liver to your bowel. PTC will allow a radiologist to identify if your bile ducts are blocked. He or she can then insert a biliary drainage tube, place a stent to bypass the blockage, or try to widen any narrow points in your bile duct. Liver Drainage tube Drainage bag Gallbladder Having these procedures will help to identify and potentially relieve the blockage in your biliary drainage system. This will allow your liver to function properly and drain any infection that can develop in the bile.

3 PREPARING FOR HAVING PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAM (PTC) AND BILIARY DRAIN/ DILATATION/STENTING Before your procedure Let the radiologist know if you take any medicines and if you have any allergies. You may need to have a blood test to check that your blood clots normally. The day of your procedure Do not have any food for six hours before your procedure and do not drink two hours beforehand. You can take all your regular medicines except any which thin your blood, such as warfarin, aspirin or clopidogrel. If you are not in hospital already, you will be admitted as a day patient. When you are on the ward, a nurse will ask you several questions about your health and any medicines you take. He or she will also check your blood pressure and pulse, and ask you to change into a gown. Your nurse will bring you to the X-ray department on your bed. In the procedure room, the radiologist will discuss what will happen during and after the procedure. He or she will also discuss with you the benefits and risks of having a PTC and biliary drain/dilatation/stenting. This is a good opportunity to ask any questions so you understand exactly what is going to happen before you sign a consent form to go ahead. WHAT HAPPENS DURING THE PROCEDURE? You will lie on your stomach on a special X-ray table. The radiologist will move your right arm away from your side and may put it behind your head. He or she will then clean the skin on your back with antiseptic fluid and cover it with a sterile drape.

4 Next, the radiologist will inject a local anaesthetic. This may sting a little at first but will then completely block pain from the area. He or she may also give you a sedative. This will help you to relax.the radiologist will insert a fine needle through your skin and into your liver. He or she will inject a dye through the needle to help your bile ducts show up on X-ray. You may get a warm feeling and a metallic taste in your mouth from the dye. The radiologist may ask you to hold your breath briefly and will then take some X-rays. He or she will look at the X-ray images to see if your bile ducts are narrowed, blocked or obstructed. If so, you may need to have one or more of the following procedures. Biliary drainage If your bile ducts are blocked or obstructed, the radiologist will insert a catheter (fine plastic tube) to drain any excess bile from your bile ducts to prevent infection, jaundice and itchy skin. Biliary dilatation If your bile ducts are narrowed, the radiologist will insert a catheter and inflate a balloon to open them up. He or she may insert a drainage catheter afterwards if necessary. Biliary stenting If your bile ducts are narrowed or you have too much bile in your liver, the radiologist will place a plastic or metallic stent across the narrowing to open it up or drain off excessive fluid. AFTER THE PROCEDURE You will return to your ward to recover, which can take a few hours. If you have a drain, your nurse will check it regularly. You will need to stay in hospital for at least one night. Exactly how long will depend on your condition and whether you need any further treatment.

5 Going home Ask the radiologist for information about how long the drain needs to stay in place (if you have one) and how long you will need to have the stent for. You can carry on with life as normal with the stent in place. ARE THERE ANY RISKS? PTC and a biliary drain, dilatation and stenting are commonly performed and generally safe. However, as with every procedure, there are some risks associated with them. The procedure may cause some bleeding inside your body. It is common to see a small amount of blood in the drainage bag. Occasionally the bleeding can be more severe and you might need to have further treatment, such as blood transfusion, another procedure, or even surgery. You may have a reaction to the dye and feel sick or get a rash on your skin too. There is also a risk of infection within the bile ducts but the radiologist will give you antibiotics before and after the procedure to try and prevent this. If the radiologist inserts a drain or a stent, it could potentially become blocked and may need to have another procedure to unblock it. HOW TO FIND US By Car The nearest long stay National Car Park (NCP) is in Cavendish Square. Short stay meter parking is also available in surrounding streets as well as on Harley Street. By Train The nearest tube stations are Regent s Park (Bakerloo line), Baker Street (Bakerloo, Circle, Hammersmith and City, Jubilee and Metropolitan lines) and Bond Street (Central and Jubilee lines).

6 O X F O R D S T R E E T O X F O R D S T S T R E E T BAKER STREET M A R Y L E B O N E C H I LT E R N S T R E E T NOTTINGHAM PLACE B L A N D F O R D S T THE HARLEY STREET CLINIC PADDINGTON ST M A R Y L E B O N E H I G H S T N E W WELBECK ST W I G M O R E S T R E E T R O A D W E Y M O U T H S T R E E T W I M P O L E S T H A A R R L L E Y S T THE HARLEY STREET CLINIC DIAGNOSTIC CENTRE M A R Y L E B O N E R D C A V E N D I S H H A R L E Y S T K R A P D E V O N S H I R E S T C A V E N D I S H P L P O R T L A N D C R E P L A C E REGENTS PARK S S T R E E T INTERVENTIONAL ONCOLOGY CENTRE G R E AT P O R T L A N D M O R T I M E R S T GREAT PORTLAND STREET B A K E R S T R E E T B A K E R S T R E G E N T S T R E E T J A M E S S T BOND STREET OXFORD CIRCUS By Bus Bus routes 18, 27, 30, 205 and 453 all stop near the top of Harley Street. Any questions, us at: Interventional Oncology Centre 80 Harley Street London W1G 8PZ T +44 (0) M +44 (0) F +44 (0)

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