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Percutaneous transhepatic cholangiography (PTC)

Percutaneous transhepatic cholangiography (PTC) is a test to find out the cause of a blockage in your bile duct. 

What is a 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.

Why you might have a PTC?

You might have a PTC if you have symptoms of a blocked bile duct such as yellowing of the skin (jaundice). Other tests such as ultrasound or an MRI scan may have shown up a blockage of the bile ducts. A PTC can find out the cause of the blockage.

You might have treatment during the test to relieve the blockage.

Preparing for a PTC

You have blood tests before having a PTC. Let your doctor know if you are taking any medicines that change how your blood clots. 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 will give you advice about this.

You can’t eat for 4 to 6 hours before the procedure. You might be able to drink water during this time. Your appointment letter will give more detail about this and give you a number to ring if you have any questions.

Tell them if you:

  • have had an allergic reaction to the dye used in the test before (the contrast medium)
  • are diabetic
  • have asthma

At the hospital

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) in to your arm or the back of your hand. They use this to give you a drug to make you sleepy (sedation), and for painkillers if needed. You also have antibiotics to prevent infection.

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

What happens

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 liver, and into the bile ducts  You may feel a twinge when the needle goes into the liver or some discomfort around your right shoulder. They use ultrasound or x-rays to help guide the needle.

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 pieces 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 if you had sedation.

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.

Possible risks

PTC is usually safe but as with any medical procedure there are possible risks. Doctors make sure the benefits of the test outweigh these risks.

The possible risks include;

  • bleeding
  • infection
  • allergic reaction to the contrast medium

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)

The amount of radiation you receive from the x-rays during the test is small and doesn't make you feel unwell.

The risk of the radiation causing any problems in the future is very small. The benefits of finding out what is wrong outweigh any risk there may be from radiation. Talk to your doctor if you are worried about the possible effects of x-rays.

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.

For information and support, you can call the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday.
Last reviewed: 
01 Dec 2020
Next review due: 
01 Dec 2023
  • Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update
    SA Khan and others 
    Gut, 2012. Volume 61, Pages 1657-1669

  • Biliary cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow up
    JW Valle and others
    Annals of Oncology, 2016. Volume 27, Pages 28-37