Percutaneous transhepatic biliary drainage: a review

Percutaneous transhepatic biliary drainage (PTBD) was conceptualized more than 35 years ago, but its clinical application only flourished in the past 10 years after a number of technical refinements. Initially it was used primarily as a means of providing palliative decompression for patients with malignant biliary obstructions. Despite a number of well-recognized problems associated with its long-term use, including relatively high prevalences of cholangitis and other catheter-related complications, PTBD remains a viable treatment for patients with advanced malignancies where few therapeutic alternatives exist. In recent years, PTBD has increasingly been employed in the management of benign biliary diseases. Since only short-term drainage is required in the majority of patients with benign diseases, much of the catheter-related complications can be avoided. Through the transhepatic tract created by PTBD, various therapeutic manipulations can be performed, including biliary lithotripsy, stricture dilatation, and sphincterotomy. The impact of PTBD in the management of benign biliary diseases is expected to increase with the development of more sophisticated transhepatic instruments and techniques. In this article, the technique and complications of PTBD are described, followed by a review of the applications of PTBD in both malignant and benign biliary diseases.