Risk of Liver Abscess Formation in Patients with Prior Biliary Intervention Following Yttrium-90 Radioembolization

Cholapranee, Aurada; Houten, Diana van; Deitrick, Ginna; Dagli, Mandeep; Sudheendra, Deepak; Mondschein, Jeffrey I.; Soulen, Michael C.

doi:10.1007/s00270-014-0947-5

Cited by 39 publications

(38 citation statements)

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“…The incidence of hepatic abscesses after radioembolization in patients with a normal biliary tree, or in the presence of a bilidigestive anastomosis, is fortunately low-less than 1% (Table 2) (13)-as opposed to less than 5% in the general TACE population and 48%-86% after TACE in the presence of a bilidigestive anastomosis (14,15). An aggressive prophylactic antibiotic regimen is therefore not advised (16,17). Radioembolization in the presence of a bilidigestive anastomosis seems safe but needs further attention, as liver abscesses after TACE show a high mortality rate of 11%-50% (15,18).…”

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confidence: 99%

⁹⁰Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

et al. 2015

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Learning Objectives: On successful completion of this activity, participants should be able to (1) describe the status of the current literature regarding new indications for radioembolization; (2) describe standard hepatic vascularization, identify common routes for extrahepatic depositions, and judge when "skeletization" of hepatic arteries could be unnecessary; and (3) appraise the different methods of activity calculation and recognize the strengths and pitfalls of pretreatment and posttreatment dosimetry.Financial Disclosure: Dr. Lam is a consultant/advisor for BTG International and a meeting participant/lecturer for SirTex Medical. The authors of this article have indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through July 2018.Radioembolization is an established treatment modality that has been subjected to many improvements over the last decade. Developments are occurring at a high pace, affecting patient selection and treatment. The aim of this review is therefore to provide an overview of current practice, with a focus on recent developments in the field of radioembolization. Several practical issues and recommendations in the application of radioembolization will be discussed, ranging from patient selection to treatment response and future applications.

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confidence: 99%

⁹⁰Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

et al. 2015

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“…Biliary anastomosis has been reported for a long time as a major risk factor for severe infectious complications after TAE and TACE (8). In these patients, RE could be an interesting alternative with early results reporting low risk of post-treatment abscess (9). TACE and TAE are contraindicated in case of major portal vein thrombosis.…”

Section: Contraindicationsmentioning

confidence: 99%

GEP-NETS UPDATE: Interventional radiology: role in the treatment of liver metastases from GEP-NETs

Baère

Deschamps

Tselikas

et al. 2015

European Journal of Endocrinology

112

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Neuroendocrine tumors from gastro-pancreatic origin (GEP-NET) can be responsible for liver metastases. Such metastases can be the dominant part of the disease as well due to the tumor burden itself or the symptoms related to such liver metastases. Intra-arterial therapies are commonly used in liver only or liver-dominant disease and encompass trans-arterial chemoembolization (TACE), trans-arterial embolization (TAE), and radioembolization (RE). TACE performed with drug emulsified in Lipiodol has been used for the past 20 years with reported overall survival in the range of 3-4 years, with objective response up to 75%. Response to TACE is higher when treatment is used as a first-line therapy and degree of liver involvement is lower. Benefit of TACE over TAE is unproven in randomized study, but reported in retrospective studies namely in pancreatic NETs. RE provides early interesting results that need to be further evaluated in terms of benefit and toxicity. Radiofrequency ablation allows control of small size and numbered liver metastases, with low invasiveness. Ideal metastases to target are one metastasis !5 cm, or three metastases !3 cm, or a sum of diameter of all metastases below 8 cm. Ablation therapies can be applied in the lung or in the bones when needed, and more invasive surgery should be probably saved for large-size metastases. Even if the indication of image-guided therapy in the treatment of GEP-NET liver metastases needs to be refined, such therapies allow for manageable invasive set of treatments able to address oligometastatic patients in liver, lung, and bones. These treatments applied locally will save the benefit and the toxicity of systemic therapy for more advanced stage of the disease.

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“…40,41 Abscess formation appears to be a much rarer event following radioembolization even despite an incompetent sphincter of Oddi, with only case reports in the literature. [42][43][44] Cholapranee et al compared a cohort of such patients following radioembolization with Y-90 resin microspheres with a cohort of patients following oily TACE. 43 Both cohorts were administered the same antibiotic regimen before and after embolization.…”

Section: Hepatic Abscess Formationmentioning

confidence: 99%

“…[42][43][44] Cholapranee et al compared a cohort of such patients following radioembolization with Y-90 resin microspheres with a cohort of patients following oily TACE. 43 Both cohorts were administered the same antibiotic regimen before and after embolization. There were no abscesses among the 16 radioembolization patients (0%), while 3 of 13 (23%) patients developed an abscess following TACE (p ¼ 0.078).…”

Section: Hepatic Abscess Formationmentioning

confidence: 99%

“…Patients without an intact sphincter of Oddi have a biliary tree colonized by intestinal flora. 43 The combination biliary ischemia/necrosis and bacterial colonization may provide the nidus for abscess development. On the other hand, bile duct injury was not seen on histologic examination of the liver during a swine study using resin Y-90 microspheres.…”

Section: Hepatic Abscess Formationmentioning

confidence: 99%

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Prevention and Management of Infectious Complications of Percutaneous Interventions

Huang

Philip

Richter

et al. 2015

Semin intervent Radiol

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Infectious complications following interventional radiology (IR) procedures can cause significant patient morbidity and, potentially, mortality. As the number and breadth of IR procedures grow, it becomes increasingly evident that interventional radiologists must possess a thorough understanding of these potential infectious complications. Furthermore, given the increasing incidence of antibiotic-resistant bacteria, emphasis on cost containment, and attention to quality of care, it is critical to have infection control strategies to maximize patient safety. This article reviews infectious complications associated with percutaneous ablation of liver tumors, transarterial embolization of liver tumors, uterine fibroid embolization, percutaneous nephrostomy, percutaneous biliary interventions, central venous catheters, and intravascular stents. Emphasis is placed on incidence, risk factors, prevention, and management. With the use of these strategies, IR procedures can be performed with reduced risk of infectious complications.

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Risk of Liver Abscess Formation in Patients with Prior Biliary Intervention Following Yttrium-90 Radioembolization

Abstract: This preliminary experience suggests that the risk of liver abscess among patients with prior biliary intervention may be lower following radioembolization than chemoembolization, which could potentially expand treatment options in this high-risk population.

Cited by 39 publications

References 14 publications

⁹⁰Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

⁹⁰Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

GEP-NETS UPDATE: Interventional radiology: role in the treatment of liver metastases from GEP-NETs

Prevention and Management of Infectious Complications of Percutaneous Interventions

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Risk of Liver Abscess Formation in Patients with Prior Biliary Intervention Following Yttrium-90 Radioembolization

Abstract: This preliminary experience suggests that the risk of liver abscess among patients with prior biliary intervention may be lower following radioembolization than chemoembolization, which could potentially expand treatment options in this high-risk population.

Cited by 39 publications

References 14 publications

90Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

90Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

GEP-NETS UPDATE: Interventional radiology: role in the treatment of liver metastases from GEP-NETs

Prevention and Management of Infectious Complications of Percutaneous Interventions

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Product

Resources

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⁹⁰Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

⁹⁰Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments