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

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 (n = 4), gelatin sponge (n = 2), and coils (n = 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.

Adverse Event Severity Grading System Applied to Percutaneous Transhepatic Biliary Metal Stenting as A One- or Two-Stage Procedure in Patients with Unresectable Malignant Extrahepatic Bile Duct Obstruction

“…However, these drawbacks could be avoided in this study, as predominantly left-sided bile duct access was chosen (24 vs. 13), and mostly internal/external plastic catheters were inserted (21 vs. 5). A further method to prevent adverse events such as bleeding or biliary leak might be preventive liver tract embolization after removal of the percutaneous transhepatic catheter [18]. However, this technique was not applied in this retrospective study.…”