Medical Oncologist
CION Cancer Clinics
Percutaneous biliary drainage and the bag you go home with | CION Cancer Clinics
Percutaneous biliary drainage, or PTBD, places a thin tube through the skin into a blocked bile duct so trapped bile can drain into a bag. It relieves jaundice, itching and infection risk, but it does not treat the cancer. This page explains why it is chosen, what happens on the day, what the words on your discharge sheet mean and which signs need hospital the same day. At CION Cancer Clinics in Hyderabad, our oncologists explain liver cancer in plain words and plan care around you and your family.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- What is percutaneous biliary drainage, and why would I need it?
- Why a drain through the skin and not a stent through the mouth?
- What actually happens during PTBD?
- What do the words about my drain mean?
- What do families often get wrong about a biliary drain?
- Who does this not suit, and what can this page not tell you?
- Common questions about PTBD
The short answer
What is percutaneous biliary drainage, and why would I need it?
Percutaneous biliary drainage, often written PTBD, is a thin plastic tube passed through the skin of your right side into a blocked bile duct inside the liver. It lets trapped bile flow out, so the jaundice, itching and risk of infection start to settle. It is a drainage procedure. It does not treat the cancer itself.
Why bile needs a way out
Bile is the green-yellow fluid the liver makes to help digest fat. It normally runs down the bile ducts into the gut. When a tumour in or near the ducts squeezes them shut, bile backs up into the liver and the blood. That is what turns the eyes and skin yellow, the urine dark and the stools pale. Backed-up bile can also become infected, which is dangerous.
Who this page is for
This page is mainly for people with bile duct cancer near the top of the ducts, called perihilar cholangiocarcinoma, where the blockage is high in the liver. The same drain is sometimes used for gallbladder cancer, pancreatic cancer or cancer that has spread to the liver from elsewhere. If your blockage has already been opened with a stent from below, read why a stent comes first instead.
Relieving the jaundice usually comes before any chemotherapy or surgery. A drain is often the first step, not the last.Why this route
Why a drain through the skin and not a stent through the mouth?
Most bile duct blockages are first tackled with ERCP, a camera passed through the mouth into the gut. Your team picks the drain through the skin when that route is likely to fall short.
The blockage is high up
Perihilar tumours sit where the left and right ducts join. Reaching and draining several separate branches from below can be hard. A drain placed from above can target the exact part of the liver that needs it.
ERCP did not work
Sometimes a stent cannot be passed through the narrowing, or it drains poorly and the jaundice stays. A drain from above is the usual next step.
The gut cannot be reached
Earlier stomach surgery, or a tumour blocking the outlet of the stomach, can make the camera route impossible.
Surgery is being planned
Before a big liver operation, surgeons often want the part of the liver that will stay behind drained cleanly. The team decides which side to drain with that plan in mind.
Your team will weigh
- Where the blockage sits on the scan
- Whether infection is already present
- Your blood clotting and any fluid in the abdomen
Not sure whether this applies to you?
Ask an oncologistOn the day
What actually happens during PTBD?
Blood tests and a plan
Your clotting and kidney tests are checked first. Blood thinners may need stopping beforehand, so tell the team every medicine you take. You will be asked not to eat for several hours.
Sedation and numbing
An interventional radiologist does the procedure. You get medicine through a drip to make you drowsy and a local anaesthetic in the skin. Antibiotics are usually given too.
Finding the duct
Using ultrasound and live X-ray pictures, a fine needle is passed between the lower ribs into a swollen bile duct. Dye shows the blockage on the screen.
Placing the tube
A wire guides a soft tube into place. Its tip curls inside the duct so it stays put. It is stitched or taped to your skin and joined to a drainage bag.
Watching afterwards
Nurses check your pulse, blood pressure and the colour of what drains. Many people stay in hospital at least overnight. Some feel shivery for a short time afterwards, which the team watches closely.
On your discharge sheet
What do the words about my drain mean?
- External drain
- The tube stops above the blockage. All the bile runs out into the bag, so the bag fills steadily.
- Internal-external drain
- The tube crosses the blockage into the gut. Bile can flow down into the bowel, and the bag can sometimes be capped off later.
- Capping
- Closing the end of an internal-external drain so bile goes inwards only. It is done only when your team says so.
- Flushing
- Pushing a small amount of sterile salt water through the tube to keep it clear. Some teams ask families to do this; others do not.
- Cholangitis
- Infection in the blocked bile ducts. It causes fever, shivering and pain, and it needs hospital treatment the same day.
- Tube change
- Drains block or wear out over time, so they are swapped at planned intervals through the same hole in the skin.
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Go to hospital today if any of these happen
A fever, shivering or shaking chills, new pain around the drain, the drain suddenly stopping, bile leaking heavily around the tube, blood in the bag, or the tube falling out or slipping back. Infection in a blocked bile duct can become serious within hours. Go to the nearest emergency department today and tell them the person has a biliary drain. If the tube comes out, cover the hole with a clean dressing and bring the tube with you. The track can close quickly.
Commonly believed
What do families often get wrong about a biliary drain?
"The drain means the cancer is being treated."
The drain treats the blockage, not the tumour. It brings the bilirubin down so that chemotherapy, surgery or other treatment can be considered safely. Your oncologist still needs to plan what comes next.
"Once the bag is attached, the person will have it for life."
Not always. Some drains are converted into an internal stent, some are removed after surgery, and some stay. Which one applies depends on the tumour and the plan, so ask what the goal is for yours.
"More bile in the bag means things are getting worse."
A steady flow usually means the drain is working. A sudden drop to almost nothing is the more worrying sign, because it can mean the tube is blocked or has moved.
"The yellow eyes should clear within a day or two."
The itching often eases first. The yellow colour usually fades slowly, over several weeks, and blood tests are a better guide than the mirror.
Being straight with you
Who does this not suit, and what can this page not tell you?
PTBD is not the right choice for everyone with jaundice. If a stent placed by ERCP can drain the liver well, most teams prefer it, because there is no tube or bag outside the body. A large amount of fluid in the abdomen, called ascites, or blood that does not clot well, can make a drain through the skin riskier. Jaundice caused by a failing liver, rather than a blocked duct, will not improve with a drain at all.
Where it is done
CION's oncologists and tumour board decide whether drainage is needed and which side to drain. CION coordinates PTBD through NABH-accredited partner hospitals with interventional radiology. Your team will tell you where the procedure takes place.
What this page cannot answer
It cannot tell you which type of drain you need, how long it will stay, or whether your cancer can be removed. Those depend on your scans and your liver tests. Bring your MRCP or CT report to your oncologist and ask. For living with the bag afterwards, read living with an external biliary drain.
If the cost of drainage is a worry, ask for a written, itemised estimate before the procedure. Prices vary by hospital and by the plan.Questions we are asked
Common questions about PTBD
Is PTBD painful?
You are sedated and the skin is numbed, so most people feel pressure rather than sharp pain during the procedure. The drain site is usually sore for some time afterwards, especially when breathing deeply. Pain relief is given. Tell the nurses if pain is getting worse rather than better.
How long does the procedure take?
It usually takes about an hour, sometimes longer when the blockage is high up or more than one side needs draining. Add the preparation and the recovery time afterwards, and most people spend the better part of a day on it, with a hospital stay after.
Can I eat normally with a drain?
Usually yes, once you are home. People with an external drain lose bile, and with it some fluid and salts, so drinking enough matters. Do not cut out protein unless a doctor tells you to. Our page on nutrition with biliary obstruction explains more.
Can the drain be turned into a stent later?
Often, yes. Once the infection has settled, the radiologist may pass a metal or plastic stent across the blockage through the same track and remove the outside tube. Whether this suits you depends on the tumour and whether surgery is still planned.
Will chemotherapy start straight away?
Usually not. Most chemotherapy needs the bilirubin to fall to a safer level first, and any infection must be treated. Your oncologist will repeat the blood tests and start treatment when the liver can handle it. This waiting is normal.
Why is the bile in the bag green, then sometimes cloudy?
Healthy bile is golden to dark green. Cloudy, thick or foul-smelling bile can mean infection. Bright red blood or clots in the bag also need a call the same day. Tell your team about any colour change you are unsure of rather than waiting.
Is PTBD covered by insurance or government schemes?
Drainage for cancer-related jaundice is often included in health insurance and in schemes such as Aarogyasri and Ayushman Bharat, but the rules differ and change over time. Check with the insurer or the scheme desk at the hospital before the procedure. CION's team can help with the paperwork.
Who decides whether I need a drain?
Your oncologist, surgeon and interventional radiologist decide together, looking at your scans and blood tests. At CION the tumour board reviews the case. If you are unsure whether a drain or a stent is right, call the helpline and ask for a second opinion.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- American Cancer Society — Palliative Therapy for Bile Duct Cancer
- Cancer Research UK — Treatment for bile duct cancer
- National Cancer Institute — Bile Duct Cancer Treatment
- NHS — Jaundice
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Living with an external biliary drainDaily care of the bag and tube once you are homeWhy a stent comes before any cancer treatmentWhy the jaundice is relieved before chemotherapy or surgeryBlocked stents, fever and when to come back urgentlyThe warning signs that need hospital the same dayPerihilar cholangiocarcinoma and the Klatskin tumourThe cancer that most often needs this drain
Talk to us
Not sure whether a drain or a stent is right?
Send us the scan and blood reports and our tumour board will look at why the jaundice is happening and what should come first. We will explain the options plainly and help you plan the next step. One helpline serves every CION centre.