Percutaneous Management of Postoperative Bile Leaks with an Ethylene Vinyl Alcohol Copolymer (Onyx)

Uller, Wibke; Müller-Wille, René; Loss, Martin; Hammer, Simone; Schleder, Stephan; Goessmann, Holger; Wiggermann, P; Stroszczynski, Christian; Wohlgemuth, Walter A.

doi:10.1055/s-0033-1350153

Cited by 14 publications

(9 citation statements)

References 6 publications

(8 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The mean duration of drainage therapy in our study was 210.1 ± 163.0 days, which is similar to that of previous reports that ranged from two to 24 months. 1,11,18,[21][22][23][24][25] Further, we found that mean duration of drainage therapy in central-type leakage tends to be longer than that of peripheral-type leakage (316.8 days vs. 156.7 days, P = 0.129). This observation, in combination with the fact that peripheral-type leakage is associated with lower leakage volume, probably accounts for why many cases of peripheral-type leakage can be resolved by PBLD alone.…”

Section: Discussionmentioning

confidence: 93%

Non-Surgical Management of Bile Leakage After Hepatectomy: A Single-Center Study

et al. 2018

View full text Add to dashboard Cite

Background Bile leakage after hepatectomy is a common complication. The purpose of the present study was to retrospectively evaluate the usefulness of non-surgical management of bile leakage after hepatectomy, using 12year data from a single center study. Methods Data from 15 patients (13 men, two women; mean age 67.1 ± 7.0 years) who had undergone nonsurgical management for bile leakage between January 2005 and November 2017 were retrospectively reviewed. Results We categorized bile leakage as central (n = 5) or peripheral (n = 10) leakage based on communication with the biliary tree. Percutaneous bile leakage drainage and/or endoscopic naso-biliary drainage (ENBD) (n = 2) or the rendezvous technique (n = 3) was successfully performed in five central-type cases, while all peripheral-type cases were treated with drainage alone; only one case required additional ethanol ablation. Bacterial bile cultures were positive in 11 cases and negative in four cases. The drainage catheters were removed after complete resolution in 13 cases (86.7%), while two patients with cases of peripheral-type leakage died due to cancer progression while the drain was in place. No case needed conversion to reoperation. The mean duration of drainage therapy in all cases was 210.1 ± 163.0 days (range 17-531 days), with 316.8 ± 180.8 days in the central type and 156.7 ± 131.5 days in the peripheral type; this duration was not significantly different (P = 0.129). Conclusion Non-surgical treatment is a minimally invasive and effective management strategy for postoperative bile leakage and the modality used depends on the type of bile leakage encountered.

show abstract

Section: Discussionmentioning

confidence: 93%

Non-Surgical Management of Bile Leakage After Hepatectomy: A Single-Center Study

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Several different interventional approaches have been proposed for the minimally invasive treatment of biliary leaks. The main materials that have been studied as potential sealants of the biliary ducts are fibrin [21], ethanol [22], glue [23], covered stents [24], vascular plugs [25] and coils [26]. Although most of the abovementioned techniques have several drawbacks [21,27], they are still employed, as there is a lack of dedicated techniques/devices enabling technically simple and efficient occlusion, especially of larger biliary leaks [17].…”

Section: Discussionmentioning

confidence: 99%

Ex Vivo Evaluation of the ArtVentive EOS Occlusion Device for the Management of Biliary Leaks

Kuetting¹,

Schild²,

Pieper³

2018

Fortschr Röntgenstr

View full text Add to dashboard Cite

Purpose Percutaneous treatment of biliary leaks is frequently required, yet technically challenging and limited to smaller fistulas. This study sought to evaluate the off-the-shelf use of the ArtVentive EOS device for the occlusion of biliary or cystic stump leaks. Materials and Methods ePTFE-covered ArtVentive EOS devices were used to perform biliary leak embolization in 5 explanted porcine livers and in 3 explanted bovine livers. After establishing standard percutaneous transhepatic biliary drainage access, artificially created biliary leaks were occluded using 5 & 8 mm EOS devices. Using the 5 mm device, peripheral (n = 3), central (n = 1) and cystic duct leaks (n = 1) were occluded. Using the 8 mm device, peripheral (n = 1), central (n = 1), main (n = 1) and cystic duct leaks (n = 2) were occluded. Total leak occlusion was controlled by cholangiography. Results Selective deployment and occlusion of central biliary leaks (3/3) and cystic stump leaks (3/3) was successful in all cases. Peripheral leaks could not be selectively catheterized in 3 out of 4 cases, making device deployment several millimeters proximal to the leaks necessary. Conclusion Selective occlusion of the cystic stump, central biliary, and larger peripheral biliary leaks using the EOS device is technically feasible ex-vivo in a single setting. Key points Citation Format

show abstract

“…Onyx® (Medtronic, Heerlen, the Netherlands) is an liquid agent used for embolization of vascular structures; it consists of an ethylene vinyl alcohol copolymer (EVOH), made opaque with micronized tantalum powder. Onyx® provides a good contrast for visualization under fluoroscopy, and so is used especially in the field of vascular interventional radiology1314 but also for bile duct leakage 1516. To the best of our knowledge, the obliteration of the main pancreatic duct with Onyx® has not yet been described.…”

Section: Introductionmentioning

confidence: 99%

How to prevent the postoperative pancreatic fistula with an ethylene vinyl alcohol copolymer (Onyx®): A proposal of a new technique

Crafa

Noviello

Moles

et al. 2018

Ann Hepatobiliary Pancreat Surg

View full text Add to dashboard Cite

Backgrounds/AimsDespite the advances in identifying risk factors, improving operative technique, and postoperative patient care, pancreatic leakage after pancreatic resection remains a highly debated topic. The aim of this study is to describe our technique and our initial experience with the intraoperative embolization of the main pancreatic duct with an Ethylene Vinyl Alcohol Copolymer (Onyx®).MethodsTwo patients of 63 and 64 years underwent pancreaticoduodenectomy for a cholangiocarcinoma of the extrahepatic bile duct and a pancreatic adenocarcinoma, respectively. At the time of pancreatic parenchyma resection, a Wirsung duct was identified and catheterized. A wirsungography was done and then, embolization with Onyx® was carried out under fluoroscopic control.ResultsNeither of the patients developed a postoperative pancreatic fistula. They were discharged to home on the 17th and 18th postoperative day, respectively. At the last follow-up, no recurrence was found. The two patients became diabetics; both needed the support of supplementary pancreatic enzymes.ConclusionsTo our knowledge, we are the first to describe this technique, which seems safe and reliable. Studies on this subject with more patients are needed to confirm the validity of this procedure.

show abstract

Percutaneous Management of Postoperative Bile Leaks with an Ethylene Vinyl Alcohol Copolymer (Onyx)

Cited by 14 publications

References 6 publications

Non-Surgical Management of Bile Leakage After Hepatectomy: A Single-Center Study

Non-Surgical Management of Bile Leakage After Hepatectomy: A Single-Center Study

Ex Vivo Evaluation of the ArtVentive EOS Occlusion Device for the Management of Biliary Leaks

How to prevent the postoperative pancreatic fistula with an ethylene vinyl alcohol copolymer (Onyx®): A proposal of a new technique

Contact Info

Product

Resources

About