REGULAR CONTENT
Final ID
632
Type
Educational Exhibit-Poster Only
Authors
M Krosin1, O Close2, E Santos3, N Mani4, R Varma5
Institutions
1University of Pittsburgh, Pittsburgh, PA, 2UPMC, Glenshaw, PA, 3N/A, Pittsburgh, PA, 4Mallinckrodt Institute of Radiology, Chesterfield, MO, 5N/A, Monroeville, PA
Purpose
Conventional approaches to biliary leaks rely on percutaneous biliary diversion drains and/or surgery. Refractory leaks face limited alternative options. Use of embolization in biliary leaks is only described in case reports and small series. This study describes initial experience treating refractory biliary leaks with microvascular plugs (MVP), liquid embolic agents, and retrievable metallic stents.
Materials & Methods
A single-center, retrospective review from 1/2011 to 9/2016 examined medical records and imaging to identify iatrogenic biliary leaks refractory to conventional management wherein alternative interventions using MVPs, liquid embolic agents, and retrievable stents were performed. Clinical follow-up was conducted with cholangiography, labs, and drain observation.
Results
Four (n=4) patients underwent subtotal hepatectomy: three for cholangiocarcinoma and one for metastatic colon adenocarcinoma; all four were diagnosed with biliary leaks. An average of 4.25 conventional procedures (σ=2.88, 0-6) including percutaneous biloma drain, percutaneous transhepatic biliary drainage (PTBD), and serial PTBD exchanges were performed per patient over an average of 161 d (σ= 134, 25-330) with refractory leaks. Two patients also had failed repeat revision laparotomy. Subsequently, one patient had seven total alternative procedures, four with N-butyl cyanoacetate (n-BCA) for tract embolization and three with sodium tetradecyl sulfate (STS) foam for biloma sclerotherapy. The other three patients had one biliary embolization procedure each with either n-BCA, an MVP, or an MVP plus a metallic retrievable stent. All patients had complete resolution of clinical, laboratory, and radiographic findings of biliary leak after an average of 52 d (σ= 81, 1-173) from initial alternative treatment. No complications are known. Two patients are deceased secondary to underlying malignancy; two remain under active surveillance.
Conclusions
Alternative approaches to biliary leaks include embolization with n-BCA, STS, MVP, and stents. These methods show early promise regarding both efficacy of treatment as well as rapidity of leak resolution versus conventional means (52 d v. 161 d, p = 0.21). Larger trials are needed.
Final ID
632
Type
Educational Exhibit-Poster Only
Authors
M Krosin1, O Close2, E Santos3, N Mani4, R Varma5
Institutions
1University of Pittsburgh, Pittsburgh, PA, 2UPMC, Glenshaw, PA, 3N/A, Pittsburgh, PA, 4Mallinckrodt Institute of Radiology, Chesterfield, MO, 5N/A, Monroeville, PA
Purpose
Conventional approaches to biliary leaks rely on percutaneous biliary diversion drains and/or surgery. Refractory leaks face limited alternative options. Use of embolization in biliary leaks is only described in case reports and small series. This study describes initial experience treating refractory biliary leaks with microvascular plugs (MVP), liquid embolic agents, and retrievable metallic stents.
Materials & Methods
A single-center, retrospective review from 1/2011 to 9/2016 examined medical records and imaging to identify iatrogenic biliary leaks refractory to conventional management wherein alternative interventions using MVPs, liquid embolic agents, and retrievable stents were performed. Clinical follow-up was conducted with cholangiography, labs, and drain observation.
Results
Four (n=4) patients underwent subtotal hepatectomy: three for cholangiocarcinoma and one for metastatic colon adenocarcinoma; all four were diagnosed with biliary leaks. An average of 4.25 conventional procedures (σ=2.88, 0-6) including percutaneous biloma drain, percutaneous transhepatic biliary drainage (PTBD), and serial PTBD exchanges were performed per patient over an average of 161 d (σ= 134, 25-330) with refractory leaks. Two patients also had failed repeat revision laparotomy. Subsequently, one patient had seven total alternative procedures, four with N-butyl cyanoacetate (n-BCA) for tract embolization and three with sodium tetradecyl sulfate (STS) foam for biloma sclerotherapy. The other three patients had one biliary embolization procedure each with either n-BCA, an MVP, or an MVP plus a metallic retrievable stent. All patients had complete resolution of clinical, laboratory, and radiographic findings of biliary leak after an average of 52 d (σ= 81, 1-173) from initial alternative treatment. No complications are known. Two patients are deceased secondary to underlying malignancy; two remain under active surveillance.
Conclusions
Alternative approaches to biliary leaks include embolization with n-BCA, STS, MVP, and stents. These methods show early promise regarding both efficacy of treatment as well as rapidity of leak resolution versus conventional means (52 d v. 161 d, p = 0.21). Larger trials are needed.