Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; new access (eg, percutaneous transhepatic c
CPT4 code
Name of the Procedure:
Injection Procedure for Cholangiography, Percutaneous
Common names: Percutaneous Transhepatic Cholangiography (PTC), Biliary Tract Imaging
Summary
This procedure involves injecting a dye into the bile ducts through the skin and liver to get detailed X-rays or ultrasound images of your bile ducts. It helps doctors diagnose and guide the treatment of issues within the biliary system.
Purpose
The procedure addresses problems such as blockages, strictures, or stones in the bile ducts. The goal is to obtain a clear image of the bile duct system to diagnose issues and plan appropriate treatments.
Indications
- Jaundice (yellowing of the skin or eyes)
- Unexplained upper abdominal pain
- Suspected bile duct stones or tumors
- Abnormal liver function tests indicating bile duct problems
Preparation
- Fasting for 6-8 hours before the procedure
- Stopping certain medications like blood thinners, as advised by your doctor
- Pre-procedure blood tests to check clotting ability and liver function
Procedure Description
- The patient lies on an examination table; local anesthesia is administered.
- Using ultrasound or fluoroscopy for guidance, a fine needle is inserted through the skin and liver into a bile duct.
- Contrast dye is injected into the bile duct system.
- X-ray or real-time imaging captures detailed pictures of the bile ducts.
- Interpretation and analysis of the images are carried out by a radiologist.
- The needle is removed, and a small bandage is applied.
Duration
The procedure typically takes about 1-2 hours.
Setting
It is usually performed in a hospital's radiology or interventional radiology department.
Personnel
- Interventional radiologist
- Radiologic technologist
- Nurse
- Anesthesiologist (if sedation is used)
Risks and Complications
- Common: Discomfort or pain at the insertion site, minor bleeding.
- Rare: Severe bleeding, infection, puncturing nearby organs, adverse reactions to the contrast dye.
Benefits
- Provides detailed images of the bile duct system.
- Helps in diagnosing the exact cause of biliary problems.
- Guides the treatment plan, potentially avoiding the need for exploratory surgery.
Recovery
- Monitoring for a few hours after the procedure to ensure no immediate complications.
- Instructions on managing mild discomfort at the puncture site.
- Resume normal activities within 24-48 hours.
- Follow-up appointments as recommended to discuss results and further treatment.
Alternatives
- Endoscopic Retrograde Cholangiopancreatography (ERCP): Involves an endoscope through the mouth to reach the bile ducts.
Magnetic Resonance Cholangiopancreatography (MRCP): A non-invasive MRI scan of the biliary and pancreatic ducts.
Pros and cons of alternatives: ERCP can also treat some conditions during the same procedure but is more invasive; MRCP is non-invasive but may not be as detailed.
Patient Experience
- You may feel pressure or mild discomfort when the needle is inserted.
- After the procedure, some soreness at the puncture site is common.
- Pain management with over-the-counter or prescribed medications as needed.
- Mostly, patients can return to their daily activities quickly, with minimal interruption.