Re: Precutanious Transhepatic Chologiogram (sorry about the spelling)

[Guest guest]

> Can someone tell me how this test is performed and if you're

sedated like with an ERCP?

A PTC is a radiology exam similar to an ERCP, just the means of

getting the contrast dye into the bile ducts is different. For a PTC

sedation is given to make you comfortable and the site of entry is

prepared with a sterile washing and drapped with a sterile sheet

(with a small window around the point of entry). The site is usually

numbed with lidocane (or other local anesthetic). A needle is stuck

through the skin (usually between the ribs) and into the liver,

where a bile duct is searched for. When a bile duct is found,

contrast is injected into the duct system so that it may be viewed

via X-ray.

There is a good illustration of a PTC at

http://www.hopkins-gi.org/pages/latin/templates/index.cfm

On the left side of the page, go into Digestive Disease Library,

pick Biliary Tract and then Primary Sclerosing Cholangitis. On the

new page on the right pick Select A Section, Diagnosis, Percutaneous

Transhepatic Cholangiography. That will get you to a brief

explanation and picture at

http://www.hopkins-gi.org/pages/latin/templates/index.cfm?

pg=disease3 & organ=3 & disease=30 & lang_id=1 & pagetype=10 & pagenum=359

(that URL may be broken into several lines, if so clicking on it

won't work, but if you paste it back together...).

> ALso, why is this test usually done?

If the common bile duct is so scarred that an ERCP does not get any

dye up into the intrahepatic ducts (those in the liver) then a PTC

may be called for. Nowdays MRI's (MRCP) are challenging PTC's for

simple visualization of the biliary tree, but the two tests don't

provide exactly the same information. PTC shows the inside of the

ducts very well, MRCP the total duct but with a little less

resolution. In addition a PTC allows placement of a stent, which can

bridge some strictures, however if the common bile duct is blocked,

I'm not sure where the stent would drain to (an external bag is

always possible, but you don't want to use that long term).

> Naturally, with PSC it's usally because

> of scarring, so wouldn't this be an unnecassry test?

If your intrahepatic ducts are in good shape and the common bile

duct is the only part of your biliary system that is gumming up the

works, a roux-en-y proceedure may be recommended to provide relief

for a while. This is what I had done in 1989, shortly after my

diagnosis with PSC. I didn't have a PTC until just over a year ago,

when because of the roux-en-y stents couldn't be placed via a ERCP

and a transheptatic stent was placed via a PTC. (This is also

illustrated at the s-Hopkins site, look in the Therapy section).

Tim R