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Percutaneous biliary drainage (PTBD), explained | CION Cancer Clinics
PTBD is a thin tube passed through the skin of the right side, through the liver and into a blocked bile duct, so that bile can drain out. It is used when a stent cannot be placed through the mouth, usually because the block sits high in the liver or the bowel is also narrowed. This page explains what happens on the day, which kind of drain you may go home with, and what needs same-day care afterwards. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is PTBD, and why has it been suggested instead of a stent?
- PTBD and an endoscopic stent, compared
- What actually happens during PTBD?
- Which kind of drain will I have?
- Four things families ask, and what is actually true
- Who PTBD does not suit, and what this page cannot tell you
- Common questions about PTBD
The short answer
What is PTBD, and why has it been suggested instead of a stent?
PTBD, percutaneous transhepatic biliary drainage, is a thin tube passed through the skin of the right side, through the liver, and into a blocked bile duct, so that bile can drain out. It is suggested when the usual route for a stent, an endoscope passed down through the mouth, cannot reach or cannot pass the block.
Why the endoscope sometimes cannot do the job
An endoscope reaches the bile duct from below, through the bowel. If the tumour has also narrowed the bowel, if the block sits high up where the ducts branch inside the liver, or if a previous operation has changed the anatomy, the endoscope cannot get there. PTBD comes from above, through the liver itself, and is not troubled by any of those.
Who does it
An interventional radiologist, a doctor who works under X-ray and ultrasound guidance rather than in an operating theatre. Your surgical oncologist and gastroenterologist decide with the radiologist whether a stent, a PTBD or an operation suits your block, and you are entitled to hear why.
PTBD relieves the block. It does not treat the tumour causing it.Side by side
PTBD and an endoscopic stent, compared
Endoscopic stent (ERCP)
PTBD through the skin
Enters through the mouth, nothing on the outside afterwards
Enters through the right side, usually leaves a tube on the skin at first
Suits blocks low down, near the pancreas
Suits blocks high up, inside the liver, or when the bowel is also narrowed
Done under sedation, often a day procedure
Done under local anaesthetic and sedation, usually a short stay
Can be repeated if the stent blocks
The tube can be flushed, exchanged, or later converted to an internal stent
Not sure whether this applies to you?
Ask an oncologistOn the day
What actually happens during PTBD?
Before you go in
Blood is checked for clotting, because the needle passes through the liver. Antibiotics are given through a drip. Tell the team about every blood thinner or diabetes medicine you take, and do not stop any of them on your own.
Numbing and finding the duct
You lie on your back on an X-ray table. The skin over the right ribs is numbed and a sedative is given through the drip. Using ultrasound, the radiologist guides a fine needle into a widened bile duct inside the liver.
Placing the tube
Dye is injected to show the ducts on X-ray and locate the block. A wire is passed, then the drainage tube over it. If the wire crosses the block, the tube can drain both outwards and into the bowel. If it cannot, the tube drains outwards only for now.
Afterwards
The tube is stitched to the skin and connected to a bag. You rest lying flat for a few hours while the team watches for bleeding. Bile in the bag is dark green and that is normal. You go home once you are eating, pain is controlled and the bag is draining well.
What you go home with
Which kind of drain will I have?
It depends on whether the wire could cross the block on the day. Ask which one you have, because the care is different.
External drain only
The tube sits above the block and every drop of bile comes out into the bag. Nothing reaches the bowel, so the stool stays pale and you can lose salt and fluid. Often a first step, with a second procedure once the swelling settles.
Internal-external drain
The tube has holes above and below the block, so bile can flow into the bowel as well as into the bag. The bag can sometimes be capped so that everything drains inwards. Still a tube on the skin, but less fluid lost.
Internal metal stent placed through the skin
Once the track has settled, a metal stent can be placed across the block through the same route and the external tube removed, leaving nothing outside. Not everyone gets to this stage. Ask whether it is planned.
Two drains, one each side
Where the block sits at the point the left and right ducts join, one tube may drain only half the liver. A second tube on the other side is sometimes needed for the jaundice to clear fully.
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Same-day signs after PTBD
Fever or shivering, fresh blood in the bag or around the tube, the bag suddenly stopping, bile leaking on to the skin, worsening pain, or the yellow colour and dark urine returning: go to an emergency department the same day and say there is a biliary drain in place. Do not remove, clamp or reposition the tube yourself.
Commonly believed
Four things families ask, and what is actually true
"A tube through the liver must be far more dangerous than an endoscope."
Both carry risks, and they are different ones. PTBD can bleed, because the needle passes through liver tissue, and the skin site can leak or become infected. Endoscopic stenting can inflame the pancreas. The route is chosen by where the block sits, not by danger alone.
"If they chose PTBD, it means the cancer is too advanced for anything else."
PTBD is chosen for anatomy, not stage. A small tumour high in the liver needs it as often as a large one does. It is also used before a planned operation, to clear jaundice so the liver is fit to be operated on.
"The bag is for life."
Often it is not. Many external drains are converted to an internal stent within weeks, or removed after a bypass operation. Some people do keep a drain long term. Ask what the plan is for yours, and when.
"Once the drain is in, we can start chemotherapy next week."
Chemotherapy usually waits until the bilirubin has fallen to a level the liver can cope with, which can take weeks. Starting earlier risks serious side effects because the drugs cannot be cleared. The oncologist sets the date from the blood tests.
Being straight with you
Who PTBD does not suit, and what this page cannot tell you
PTBD is harder or riskier when the bile ducts are not widened enough to find with a needle, when there is a lot of fluid around the liver, when clotting is poor and cannot be corrected, or when the tumour has replaced most of the liver. In those situations the team may prefer another route, or may talk with you about whether draining is the right thing at all.
What it cannot promise
A drain that works well does not mean the jaundice will clear completely. If part of the liver stays blocked, or the liver has been under pressure for a long time, the bilirubin may fall slowly or only partly. Ask the team what a good result looks like for you before the procedure.
What to ask before you agree
Ask why PTBD rather than a stent through the mouth. Ask whether the plan is to convert the tube to an internal stent, and roughly when. Ask who will teach you to look after the tube at home, and whom to call at night.
This page cannot tell you whether the tumour behind the block can be removed or treated. That comes from the scans and the biopsy, and from a tumour board, not from a drainage page.Questions we are asked
Common questions about PTBD
Is PTBD painful?
The skin and the liver surface are numbed and you are sedated, so most people feel pressure rather than pain during it. The tube site is sore for some days afterwards, particularly when breathing deeply or turning in bed, and pain medicine is given for that. Tell the team if it worsens rather than eases.
How long will I be in hospital?
Usually a short stay. You are watched for bleeding and fever on the first night, and you go home once you are eating, the pain is controlled and the bag is draining. A longer stay is needed if the bile was infected before the procedure.
Will the jaundice go away completely?
Often, but not always, and not quickly. The bilirubin usually starts to fall within days and the colour fades over weeks. If only one side of the liver is draining, or it has been blocked for a long time, the fall can be slow or partial. The blood test, not the skin, tells the team how it is going.
Can I bathe with the drain in?
A shower is usually fine once the site has settled, with the dressing covered and changed afterwards. Soaking in a bath, a tank or a river is not, because water can track along the tube into the liver. Your nurse will show you how to secure the tube while you wash.
Why is my stool still pale after the drain?
Because with an external-only drain, all the bile leaves through the tube and none reaches the bowel, so pale stool is expected. If your drain is meant to drain inwards as well and the stool suddenly turns pale again, the internal part may have blocked, and the team should check it.
Can PTBD be done if the cancer is in the pancreas?
Yes. Pancreatic cancer blocks the bile duct low down, where an endoscopic stent is usually tried first. PTBD is used when that fails, when the bowel is also narrowed, or when earlier surgery has changed the anatomy. The route depends on the block, not on where the cancer started.
What if the wire could not cross the block?
Then you go home with an external-only drain and a second attempt is usually planned once the swelling in the duct has settled and the track has matured. Second attempts often succeed. If they do not, the team will discuss a long-term external drain or a surgical bypass.
Is PTBD covered by Aarogyasri or insurance?
Usually, when it is part of an approved cancer treatment plan. Aarogyasri, CGHS, ECHS and EHS are accepted at CION and most cashless insurers are empanelled. Drain bags, dressings and later exchanges are separate items, so ask what the approval covers.
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Sources
- Cancer Research UK — Bile duct cancer: treatment
- National Cancer Institute — Bile Duct Cancer (Cholangiocarcinoma) Treatment (PDQ), patient version
- American Cancer Society — Palliative therapy for bile duct cancer
- Macmillan Cancer Support — Bile duct cancer
- 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.
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Been told you need a drain through the skin?
Send us the scan report or call the helpline. A surgical oncologist will explain why this route has been suggested and what the plan for the tube is. One helpline serves every CION centre.