Percutaneous transhepatic biliary tract embolization using gelatin sponge

Abstract

Background Percutaneous biliary drainage (PTBD) is a necessary procedure in several benign and malignant conditions. After PTBD removal biliocutaneous fistula is a rare but potential complication. Different embolization agents have been used for transhepatic catheter tract embolization in the past, while there is only little experience using gelatin sponge for this procedure. Purpose To evaluate the feasibility and safety of PTBD tract embolization with gelatin sponge. Material and Methods Between July 2008 and August 2017, 98 patients have been treated with PTBD access embolization using gelatin sponge. PTBD was performed in patients with malignant (67%) or benign (33%) bile duct obstruction. Outcome measures included technical success (complete cessation of bile flow out of the percutaneous access tract), clinical success (intermediate and long-term absence of biliocutaneous fistula, absence of right upper quadrant pain as typical symptom for bile leakage into the peritoneal cavity and absence of hemorrhage out of the catheter tract during follow-up inspections), and the rate of major and minor complications. Results Technical success with effective control of bile flow out of the percutaneous access tract was achieved in 97/98 patients (99.0%). Clinical success attributed to gelatin sponge embolization was documented in 96/98 procedures (98.0%). In one case, slight bleeding out of the percutaneous drainage tract occurred after drainage removal and embolization of the access tract. Bleeding was self-limiting; no blood transfusion or surgical intervention was necessary. Conclusion PTBD tract embolization with gelatin sponge is a feasible and safe method with a low rate of therapeutically relevant complications.

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

“…Based on the Newcastle-Ottawa scale assessment, 1 study was of high quality [ 15 ], 5 were of moderate quality [ 7 , 12 – 14 , 16 ], and 1 was of low quality [ 17 ]. Quality assessment is summarized in Table 1 .…”

“…The indication for PBI was mainly malign bile duct obstruction (not always specified) in all studies with 252/314 (80.3%, range: 61.9–100%). Patients with malign bile duct obstruction were mixed with patients with an underlying benign disease such as bile duct stones in 5 of 7 studies [ 7 , 12 , 14 – 16 ]. Only in two retrospective nonrandomised cohort studies, all patients showed a malign bile duct obstruction with concomitant ascites [ 13 , 17 ].…”

“…Cyanoacrylate followed by N -butyl cyanoacrylate (NBCA) was used as an embolic agent in 4 studies [ 7 , 12 – 14 ], gelatin in 2 [ 15 , 16 ], and coils in 1 study [ 17 ].…”

“…In the other patient, the occluded biliary metal stent could be reopened by an inserted balloon angioplasty catheter [ 13 ]. The pain was related to cyanoacrylate injection in one study (8/42 (19.0%)) and qualified as mild (visual analogue scale ≤5) [ 16 ]. However, this was the only study in which the patients received local anaesthetics and did not receive analgosedation.…”

“…The second study with gelatin embolisation which exclusively reported the effect of embolisation on PBI-related haemorrhage showed a reduction of bleeding events and lesser blood transfusions but failed to show a significant difference to the nonembolisation group if only bleeding events proven by imaging methods were calculated (6/101 versus 1/92; p =0.074) [ 15 ]. In the 5 cohort studies without a control group in which efficacy of PTTE could not be calculated, adverse events related to PBI were reported in follow-up periods with a median from 66 to 361 days [ 7 , 13 , 14 , 16 , 17 ]. Overall, adverse events related to PBI which should have been prevented by PTTE such as a biliary leak, transhepatic tract bleeding, and pain were observed in 7/201 (3.5%), 1/293 (0.3%), and 17/46 (36.9%) patients ( Table 3 ).…”