The Risk Assessment and Clinical Research of Bile Duct Injury After Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

Abstract

Purpose To retrospectively evaluate the risk factors and the clinical outcomes of bile duct injury after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) and to evaluate factors that aid clinical detection and subsequent treatment of the injured bile duct. Materials and Methods All patients undergoing TACE for HCC were retrospectively reviewed for identification of bile duct injury. The clinical spectrum of all the patients analyzed including patients’ demographics, laboratory data, radiologic imaging and mode of treatment. Results From January 2015 to December 2017, a total of 21 patients (4.3%) out of 483 patients with 693 TACE procedures were identified to have bile duct injury at our single institution. There were 17 males and 4 females, with a mean age of 59.8±11.6 years (range 34–84). About 14.3% (3/21) patients show the high-density shadow around the bile duct wall in one week non-enhanced CT, and 76.2% (16/21) cases ALP>200 U/L, all these patients showed bile duct injury on the subsequent follow-up CT. Post-TACE follow-up blood biochemistry showed that alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) increased significantly compared with pre-TACE level. The incidence of various types of bile duct injuries on CT was intrahepatic bile duct dilatation (57.1%), biloma (25.7%) and hepatic hilar biliary strictures (17.1%), respectively. Patients with prior hepatectomy as well as proximal arterial chemoembolization carried a higher risk of post-TACE bile duct injury in terms of microvascular damage to the peribiliary capillary plexus. Conclusion Bile duct injury complicating TACE is not caused by a single factor, but by a variety of factors, and is closely related to the microvascular compromise of the bile ducts and subsequent chronic biliary infection. Lipiodol deposited along the bile duct wall and the sharp rise of ALP>200 U/L in one week after TACE can predict bile duct injury and early intervention may prevent the occurrence of serious complications. The probability of bile duct injury in patients with prior hepatectomy and proximal arterial chemoembolization increases significantly.

The impact of liver abscess formation on prognosis of patients with malignant liver tumors after transarterial chemoembolization

“…bile duct (8,20). Meanwhile, the local toxicity of chemoembolic agents and the embolization of bile duct feeding vessels resulting from TACE may lead to bile duct injury (21). In this study, patients had received an average of 2.31 ± 2.24 TACE sessions at the time of liver abscess formation; among them, one patient developed liver abscesses after the second and ninth TACE sessions.…”

Transarterial Bleomycin–Lipiodol Chemoembolization for the Treatment of Giant Hepatic Hemangiomas: An Assessment of Effectiveness

“…Bile duct complications are infrequent, occurring in only 0.87-4% of cases [64][65][66]. The biliary ducts have a distinct vascular supply.…”

Liver abscess formation after transarterial chemoembolization in patients with malignant hepatic tumors: a systematic review and meta-analysis

“…Some studies have shown that Oddi sphincter dysfunction or incision enables intestinal bacteria to enter (in a retrograde manner) and colonize the bile duct [4,44]. Moreover, the local toxicity of chemoembolic agents and the embolization of vessels feeding the bile duct as a result of TACE may lead to bile duct injury [45]. Bile duct injury after TACE may enable opportunistic pathogens to colonize the bile duct and enter the liver parenchyma, where they proliferate rapidly within the local ischemic and hypoxic microenvironment after TACE, thus leading to liver abscess formation.…”