Acetic Acid Sclerotherapy for Treatment of a Biliary Leak from an Isolated Bile Duct after Hepatic Surgery

Park, Ju-Hyun; Oh, Joo Hyeong; Yoon, Yup; Hong, Seoung‐Jin; Park, Sang Joon

doi:10.1097/01.rvi.0000157778.48280.ad

Cited by 22 publications

(29 citation statements)

References 9 publications

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“…These investigators also reported that the killing effect reached a plateau at a concentration of 50% (approximately 8 mol/L) (13). Acetic acid has also been safely used for the treatment of hepatocellular carcinoma, renal cysts, lymphangioma, and bile leakage from an isolated bile duct (13)(14)(15)(16)(17). Getrajdman et al (6), Lindberg et al (8), Kannegieter et al (9), and Majeed et al (12) also used acetic acid for gallbladder sclerosis in previous studies.…”

Section: Discussionmentioning

confidence: 92%

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Chemical Ablation of the Gallbladder with Acetic Acid

Lee

Won

Bae

et al. 2009

Journal of Vascular and Interventional Radiology

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PURPOSE: Chemical ablation of the gallbladder may be a useful alternative to surgery for inoperable disease. The purpose of this study was to investigate the feasibility of chemical ablation of the gallbladder with acetic acid in a canine model. MATERIALS AND METHODS:Five beagle dogs underwent percutaneous transhepatic cholecystostomy. Percutaneous occlusion of the cystic duct was performed with use of n-butyl cyanoacrylate (NBCA) and coils. After confirmation of occlusion of the cystic duct, sclerotherapy of the gallbladder was performed with 4 -7 mL of 50% acetic acid through the drainage catheter. Acetic acid was retained for 20 minutes with intermittent position change. The drainage catheter was removed immediately after sclerotherapy. The dogs were euthanized 8 weeks after the procedure. The gallbladders and adjacent organs were evaluated grossly as well as microscopically.RESULTS: All dogs survived without serious complications during the experimental period. Sclerotherapy was technically successful in all dogs. Gross specimens of the gallbladder showed shrinkage and fibrotic change without retention of any bile, mucus, or pus. Histologic examinations from the body and fundus of the gallbladder demonstrated complete ablation of the mucosa. However, the neck region of the gallbladder near the cystic duct, where NBCA and coils for cystic duct occlusion were located, had focal areas of remnant or regenerating mucosa.CONCLUSIONS: Chemical ablation of the gallbladder with 50% acetic acid was effective and safe. Complete ablation was achieved in the majority of gallbladder mucosa except for a small portion located in the gallbladder neck.

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Section: Discussionmentioning

confidence: 92%

“…Acetic acid, a sclerosing agent that has a desiccating action on proteins and can induce coagulation necrosis, has been demonstrated as an effective and safe agent to treat hepatocellular carcinoma, renal cysts, lymphangioma, and bile leakage from an isolated bile duct (13)(14)(15)(16)(17).…”

mentioning

confidence: 99%

Chemical Ablation of the Gallbladder with Acetic Acid

Lee

Won

Bae

et al. 2009

Journal of Vascular and Interventional Radiology

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“…If the leak persists beyond approximately 8 weeks, treatment with Roux-en-Y hepaticojejunostomy is usually indicated [5]. However, reoperation can present a technical problem due to dense adhesion as well as high mortality and morbidity, therefore reoperation is an option that both surgeons and patients want to avoid whenever possible [267]. …”

Section: Discussionmentioning

confidence: 99%

“…However, biliary leak from an isolated bile duct does not communicate with the main biliary system [6]. For this reason, nonoperative interventional treatment such as a biliary sclerotherapy can be a very attractive alternative because biliary sclerotherapy is known to induce atrophy of the infused hepatic segments with compensatory hypertrophy of the noninfused segments, as in portal vein embolization [7]. …”

Section: Discussionmentioning

confidence: 99%

“…In another report by Kyokane et al [9], the isolated bile duct was treated with 6 sessions of ethanol infusion. However, Park et al [7] reported that ablation of an isolated bile duct was successfully performed with 50% acetic acid in only 4 sessions. Ethanol is generally used as an injected agent percutaneously or angiographically for the treatment of various tumors because of its highly destructive properties, which lead to cell death by causing cell membrane lysis and protein denaturation [7].…”

Section: Discussionmentioning

confidence: 99%

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Acetic acid sclerotherapy for treatment of biliary leak from an isolated right posterior sectoral duct after cholecystectomy

2017

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Bile duct injury is one of the most serious complications of both laparoscopic and open cholecystectomy. Isolated bile duct injury can occur from the misidentification of aberrant right hepatic ducts, and it is troublesome because the early diagnosis is easy to miss and the definite treatment is controversial. We report a case of an isolated right posterior sectoral duct injury following cholecystectomy managed successfully with acetic acid sclerotherapy combined with coil embolization for a fistula tract.

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Treatment strategy for isolated bile leakage after hepatectomy: Literature review

Kubo

Shirabe

2019

Annals of Gastroent Surgery

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Isolated bile leakage (IBL) after hepatectomy is intractable, and various treatment methods for it have been reported. This review aimed to clarify the treatment strategy for IBL by summarizing studies on IBL after hepatectomy without extrahepatic bile duct resection. Thirty‐three cases of IBL were reported. The incidence of IBL is very low, accounting for 0.1%–1% of all hepatectomy cases. The risk factors for IBL are unclear; however, several reports mention that biliary anomaly is associated with a high risk of IBL, with preoperative and intraoperative confirmation of biliary tree anatomy being the most important preventive strategy. Treatment methods for IBL include liver resection, bilioenteric anastomosis, endoscopic treatment, bile duct ablation, percutaneous transhepatic portal vein embolization (PTPE), transcatheter arterial embolization, and use of fibrin glue. The therapeutic methods should be chosen depending on remnant liver function, amount of bile leakage, and the liver volume causing the bile leakage. When there is bile leakage from less than one segment, non‐surgical treatment is recommended, whereas when there is bile leakage from one or more segments, surgical treatment can be recommended. Nevertheless, recently, non‐surgical treatment such as PTPE, PTPE with bile duct ablation, and endoscopic methods have been considered as effective treatment approaches.

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Acetic Acid Sclerotherapy for Treatment of a Biliary Leak from an Isolated Bile Duct after Hepatic Surgery

Cited by 22 publications

References 9 publications

Chemical Ablation of the Gallbladder with Acetic Acid

Chemical Ablation of the Gallbladder with Acetic Acid

Acetic acid sclerotherapy for treatment of biliary leak from an isolated right posterior sectoral duct after cholecystectomy

Treatment strategy for isolated bile leakage after hepatectomy: Literature review

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