Percutaneous Embolization of Biliary Leaks: A Systematic Interdisciplinary Review and Proposal for a New Classification

Abstract

Objectives Biliary leak can be treated by percutaneous biliary embolization. The aim of this systematic interdisciplinary review was to analyze available reports on percutaneous embolization of biliary leak.

Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach to perform literature database search. The following terms were systematically analyzed: type of embolic agent, success rates, embolization-related adverse events, cause of biliary leak, fistula connection type, anatomic bile duct variants, and access routes.

Results Of 713 publications identified, 45 reports with 101 patients were included. Six temporary and 4 permanent embolic agents were used in 55/101 (54.5%) and 46/101 (45.5%) patients; combined in 18/101 patients (17.8%). Bile leak was successfully embolized in 97/101 (96.0%) patients, in 48/101 (47.5%) patients after repeated procedures with the same agent, and in 4/101 (3.9%) patients after a failed embolization with other agents: isolated bile duct fistula (n = 2), intrahepatic fistula after liver resection, and biliary-bronchial fistula. Five types of biliary leak were associated with the following success rates: (A) common bile duct (CBD) or cystic duct: 4/4 (100%); (B) intrahepatic bile duct (IHBD), communicating with CBD: 16/18 (88.9%); (C) isolated IHBD: 49/51 (96%); (D) CBD or cystic duct, bile duct system (BDS) not accessible by endoscopic retrograde cholangiopancreatography (ERCP): 7/7 (100%); and (E) IHBD, communicating with CBD, BDS not accessible by ERCP: 9/9 (100%).

Conclusions Embolization was highly successful without clear preference for one embolic agent. A new classification of biliary leak is proposed to direct nonsurgical treatments.

Keywords

embolization - fistula - therapeutic - radiology - interventional - cholangiopancreatography - endoscopic retrograde

• References

• 1 Saad WE, Darcy MD. Percutaneous management of biliary leaks: biliary embosclerosis and ablation. Tech Vasc Interv Radiol 2008; 11 (02) 111-119
• 2 Kwon CI, Song SH, Hahm KB, Ko KH. Unusual complications related to endoscopic retrograde cholangiopancreatography and its endoscopic treatment. Clin Endosc 2013; 46 (03) 251-259
• 3 Mueller PR, van Sonnenberg E, Ferrucci Jr JT. Percutaneous biliary drainage: technical and catheter-related problems in 200 procedures. AJR Am J Roentgenol 1982; 138 (01) 17-23
• 4 Liu YS, Lin CY, Chuang MT, Tsai YS, Wang CK, Ou MC. Success and complications of percutaneous transhepatic biliary drainage are influenced by liver entry segment and level of catheter placement. Abdom Radiol (NY) 2018; 43 (03) 713-722
• 5 Paajanen H, Suuronen S, Eskelinen M, Hytonen S, Juvonen P. Frequency of bile leak after laparoscopic cholecystectomy: audit of a surgical residency program. Am Surg 2014; 80 (01) 91-94
• 6 Zimmitti G, Roses RE, Andreou A. , et al. Greater complexity of liver surgery is not associated with an increased incidence of liver-related complications except for bile leak: an experience with 2,628 consecutive resections. J Gastrointest Surg 2013; 17 (01) 57-64 , discussion 64–65
• 7 de Castro SM, Kuhlmann KF, Busch OR. , et al. Incidence and management of biliary leakage after hepaticojejunostomy. J Gastrointest Surg 2005; 9 (08) 1163-1171 , discussion 1171–1173
• 8 Ito A, Ebata T, Yokoyama Y. , et al. Ethanol ablation for refractory bile leakage after complex hepatectomy. Br J Surg 2018; 105 (08) 1036-1043
• 9 Guillaud A, Pery C, Campillo B, Lourdais A, Sulpice L, Boudjema K. Incidence and predictive factors of clinically relevant bile leakage in the modern era of liver resections. HPB (Oxford) 2013; 15 (03) 224-229
• 10 Perera MT, Monaco A, Silva MA. , et al. Laparoscopic posterior sectoral bile duct injury: the emerging role of nonoperative management with improved long-term results after delayed diagnosis. Surg Endosc 2011; 25 (08) 2684-2691
• 11 Adler DG, Papachristou GI, Taylor LJ. , et al. Clinical outcomes in patients with bile leaks treated via ERCP with regard to the timing of ERCP: a large multicenter study. Gastrointest Endosc 2017; 85 (04) 766-772
• 12 Seewald S, Groth S, Sriram PV. , et al. Endoscopic treatment of biliary leakage with n-butyl-2 cyanoacrylate. Gastrointest Endosc 2002; 56 (06) 916-919
• 13 Sheth RA, Sabir S, Krishnamurthy S. , et al. Endovascular embolization by transcatheter delivery of particles: past, present, and future. J Funct Biomater 2017; 8 (02) E12
• 14 Shamseer L, Moher D, Clarke M. , et al; PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 2015; 350: g7647
• 15 Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Intervent Radiol 2017; 40 (08) 1141-1146
• 16 Takeuchi Y, Morishita H, Sato Y. , et al; Committee of Practice Guidelines of the Japanese Society of Interventional Radiology. Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition. Jpn J Radiol 2014; 32 (08) 500-517
• 17 Lopera JE. The amplatzer vascular plug: review of evolution and current applications. Semin Intervent Radiol 2015; 32 (04) 356-369
• 18 Löbel W. Treatment of postoperative biliary fistulas by balloon tamponade [in Undetermined Language]. Langenbecks Arch Klin Chir Ver Dtsch Z Chir 1953; 276: 745-749
• 19 Kolber MK, Shukla PA, Kumar A, Silberzweig JE. Ethylene vinyl alcohol copolymer (onyx) embolization for acute hemorrhage: a systematic review of peripheral applications. J Vasc Interv Radiol 2015; 26 (06) 809-815
• 20 Horowitz B, Busch M. Estimating the pathogen safety of manufactured human plasma products: application to fibrin sealants and to thrombin. Transfusion 2008; 48 (08) 1739-1753
• 21 Kawamura M, Sawafuji M, Watanabe M, Horinouchi H, Kobayashi K. Frequency of transmission of human parvovirus B19 infection by fibrin sealant used during thoracic surgery. Ann Thorac Surg 2002; 73 (04) 1098-1100
• 22 Hellstern P, Solheim BG. The use of solvent/detergent treatment in pathogen reduction of plasma. Transfus Med Hemother 2011; 38 (01) 65-70
• 23 Isenburg J, Penegor S, Beam S. , et al. Preclinical evaluation of a bioresorbable device for transhepatic tract closure. J Vasc Interv Radiol 2016; 27 (03) S296
• 24 Dale AP, Khan R, Mathew A. , et al. Hepatic tract plug-embolisation after biliary stenting. Is it worthwhile?. Cardiovasc Intervent Radiol 2015; 38 (05) 1244-1251
• 25 Augustin AM, Cao V, Fluck F, Kunz J, Bley T, Kickuth R. Percutaneous transhepatic biliary tract embolization using gelatin sponge. Acta Radiol 2019; 60 (10) 1194-1199
• 26 Gaba RC, Kobayashi KR, Bui JT. , et al. Liver track embolization after islet cell transplant: comparison of two techniques. AJR Am J Roentgenol 2017; 208 (05) 1134-1140
• 27 Uysal F, Obuz F, Uçar A, Seçil M, Igci E, Dicle O. Anatomic variations of the intrahepatic bile ducts: analysis of magnetic resonance cholangiopancreatography in 1011 consecutive patients. Digestion 2014; 89 (03) 194-200
• 28 Liao GQ, Wang H, Zhu GY, Zhu KB, Lv FX, Tai S. Management of acquired bronchobiliary fistula: a systematic literature review of 68 cases published in 30 years. World J Gastroenterol 2011; 17 (33) 3842-3849
• 29 Schelhammer F, Dahl SV, Heintges T, Fürst G. A multimodal approach in coil embolization of a bile leak following cholecystectomy. Cardiovasc Intervent Radiol 2007; 30 (03) 529-530
• 30 Krige JE, Bornman PC, Beningfield SJ, Nieuwoudt JH, Terblanche J. Endoscopic embolization of external biliary fistulae. Br J Surg 1990; 77 (05) 581-583
• 31 Shao XD, Qi XS, Guo XZ. Endoscopic retrograde cholangiopancreatography with double balloon enteroscope in patients with altered gastrointestinal anatomy: a meta-analysis. Saudi J Gastroenterol 2017; 23 (03) 150-160
• 32 Choi EK, Chiorean MV, Coté GA. , et al. ERCP via gastrostomy vs. double balloon enteroscopy in patients with prior bariatric Roux-en-Y gastric bypass surgery. Surg Endosc 2013; 27 (08) 2894-2899
• 33 Mutignani M, Forti E, Dokas S. , et al. Endotherapy for bile leaks from isolated ducts after hepatic resection: a long awaited challenge. Dig Liver Dis 2017; 49 (08) 893-897
• 34 Koch M, Garden OJ, Padbury R. , et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 2011; 149 (05) 680-688
• 35 Nagano Y, Togo S, Tanaka K. , et al. Risk factors and management of bile leakage after hepatic resection. World J Surg 2003; 27 (06) 695-698