Preventive Transhepatic Tract Embolisation After Percutaneous Biliary Interventions: A Systematic Review

Overview

Journal Can J Gastroenterol Hepatol

Specialty Gastroenterology

Date 2020 Oct 21

PMID 33083384

Authors

Daniel Schmitz

De-Hua Chang

Jochen Rudi

Svetlana Hetjens

Matthias P A Ebert

Affiliations

Soon will be listed here.

Abstract

Preventive transhepatic tract embolisation (PTTE) after percutaneous biliary intervention (PBI) may reduce adverse events. The aim of this systematic review was to analyse feasibility, safety, and efficacy of PTTE with different embolic agents. A systematic literature research was performed according to the PRISMA guidelines. The identified studies were analysed concerning study quality, number of cases, indication, embolic agent, embolisation technique, success, and embolisation-related adverse events. Out of 62 identified records, 7 studies of mainly moderate study quality published through 2019 were included for further analysis. Cyanoacrylate ( = 4), gelatin sponge ( = 2), and coils ( = 1) were used as embolic agents in a total number of 314 patients. Technical success was 96-100%. Embolisation-related adverse events (glue migration, pain) occurred in 10/314 (3.2%) patients. Reduction of PBI-related pain was approved by one controlled study; haemorrhage events were reduced but not clearly significant. Overall, biliary leak, transhepatic bleeding, and PBI-related pain occurred in 7/201 (3.5%), 1/293 (0.3%), and 17/46 (36.9%) documented patients after PTTE. Adverse events which likely could not have been prevented by PTTE occurred in 23/180 (12.8%) patients. Embolic agents were not compared. In conclusion, PTTE is feasible and safe. It is effective concerning the prevention of PBI-related pain, and it may be effective concerning haemorrhage. Prevention of biliary leak is not proven. It remains unclear which embolic agent should be preferred. A prospective randomised trial including all preventable adverse events is lacking.

References

Venkatanarasimha N, Damodharan K, Gogna A, Leong S, Too C, Patel A . Diagnosis and Management of Complications from Percutaneous Biliary Tract Interventions. Radiographics. 2017; 37(2):665-680. DOI: 10.1148/rg.2017160159. View

Augustin A, Cao V, Fluck F, Kunz J, Bley T, Kickuth R . Percutaneous transhepatic biliary tract embolization using gelatin sponge. Acta Radiol. 2019; 60(10):1194-1199. DOI: 10.1177/0284185118820049. View

Hunt J, Gallagher P, Heintze S, Waugh R, Shiel G . Percutaneous microcoil embolization of intraperitoneal intrahepatic and extrahepatic biliary fistulas. Aust N Z J Surg. 1997; 67(7):424-7. DOI: 10.1111/j.1445-2197.1997.tb02007.x. View

Schmitz-Rode T, Blaum M, Hubner D, Gunther R . [Catheter tract embolization after percutaneous transhepatic biliary intervention]. Rofo. 2000; 172(2):179-83. DOI: 10.1055/s-2000-7955. View

Hill H, Beecham Chick J, Hage A, Srinivasa R . N-butyl cyanoacrylate embolotherapy: techniques, complications, and management. Diagn Interv Radiol. 2018; 24(2):98-103. PMC: 5873510. DOI: 10.5152/dir.2018.17432. View

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339:b2700. PMC: 2714672. DOI: 10.1136/bmj.b2700. View

Sandroussi C, Lemech L, Grunewald B, Abraham N, Gallagher P . Late complication following coil embolization of a biliary leak. ANZ J Surg. 2005; 75(7):614-5. DOI: 10.1111/j.1445-2197.2005.03444.x. View

Abdel Aal A, Jones D, Caraway J, Moustafa A, Moawad S, Underwood E . Percutaneous embolization of cystic duct stump leak following failed endoscopic management. Radiol Case Rep. 2018; 12(4):786-789. PMC: 5823386. DOI: 10.1016/j.radcr.2017.06.013. View

Kim H, Kwon S, Oh J, Shin J, Dong S, Park M . Percutaneous Transhepatic Embolization of a Bronchobiliary Fistula Developing Secondary to a Biloma After Conventional Transarterial Chemoembolization in a Patient with Hepatocellular Carcinoma. Cardiovasc Intervent Radiol. 2015; 39(4):628-31. DOI: 10.1007/s00270-015-1224-y. View

10.

Takeuchi Y, Morishita H, Sato Y, Hamaguchi S, Sakamoto N, Tokue H . Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition. Jpn J Radiol. 2014; 32(8):500-17. DOI: 10.1007/s11604-014-0328-7. View

11.

Dale A, Khan R, Mathew A, Hersey N, Peck R, Lee F . Hepatic Tract Plug-Embolisation After Biliary Stenting. Is It Worthwhile?. Cardiovasc Intervent Radiol. 2015; 38(5):1244-51. DOI: 10.1007/s00270-015-1058-7. View

12.

Saad W, Davies M, Darcy M . Management of bleeding after percutaneous transhepatic cholangiography or transhepatic biliary drain placement. Tech Vasc Interv Radiol. 2008; 11(1):60-71. DOI: 10.1053/j.tvir.2008.05.007. View

13.

Filippiadis D, Binkert C, Pellerin O, Hoffmann R, Krajina A, Pereira P . Cirse Quality Assurance Document and Standards for Classification of Complications: The Cirse Classification System. Cardiovasc Intervent Radiol. 2017; 40(8):1141-1146. DOI: 10.1007/s00270-017-1703-4. View

14.

Shimizu H, Kato A, Takayashiki T, Kuboki S, Ohtsuka M, Yoshitomi H . Peripheral portal vein-oriented non-dilated bile duct puncture for percutaneous transhepatic biliary drainage. World J Gastroenterol. 2015; 21(44):12628-34. PMC: 4658617. DOI: 10.3748/wjg.v21.i44.12628. View

15.

Allison D, Adam A . Percutaneous liver biopsy and track embolization with steel coils. Radiology. 1988; 169(1):261-3. DOI: 10.1148/radiology.169.1.3420270. View

16.

Sharaiha R, Khan M, Kamal F, Tyberg A, Tombazzi C, Ali B . Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis. Gastrointest Endosc. 2017; 85(5):904-914. DOI: 10.1016/j.gie.2016.12.023. View

17.

Hwang J, Byeon J, Shim D, Kim S, Shin Y, Kim K . Transhepatic Tract Embolisation After Biliary Intervention Using n-Butyl Cyanoacrylate and Autologous Blood: A Retrospective Analysis of 42 Patients. Cardiovasc Intervent Radiol. 2019; 42(8):1199-1203. DOI: 10.1007/s00270-019-02237-2. View

18.

Lyon S, Terhaar O, Given M, ODwyer H, McGrath F, Lee M . Percutaneous embolization of transhepatic tracks for biliary intervention. Cardiovasc Intervent Radiol. 2006; 29(6):1011-4. DOI: 10.1007/s00270-005-0183-0. View

19.

Perez-Johnston R, Deipolyi A, Covey A . Percutaneous Biliary Interventions. Gastroenterol Clin North Am. 2018; 47(3):621-641. DOI: 10.1016/j.gtc.2018.04.008. View

20.

Robson P, Heffernan N, Gonen M, Thornton R, Brody L, Holmes R . Prospective study of outcomes after percutaneous biliary drainage for malignant biliary obstruction. Ann Surg Oncol. 2010; 17(9):2303-11. PMC: 4435845. DOI: 10.1245/s10434-010-1045-9. View