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Shim DJ, Gwon DI, Ko GY, Yoon HK, Sung KB. Transjugular insertion of biliary stent in patients with malignant biliary obstruction complicated by ascites with/without coagulopathy: a prospective study of 12 patients. ACTA ACUST UNITED AC 2019; 25:465-470. [PMID: 31650963 DOI: 10.5152/dir.2019.18470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE In patients with malignant biliary obstruction complicated by massive ascites, when endoscopy fails, safe routes for biliary decompression are needed as an alternative to percutaneous approach. We aimed to evaluate the safety and effectiveness of transjugular insertion of biliary stent (TIBS) in patients with malignant biliary obstruction complicated by massive ascites with or without coagulopathy. METHODS From March 2012 to December 2017, a total of 12 consecutive patients with malignant biliary obstructions treated with TIBS were enrolled in this study. Five patients had jaundice and cholangitis, while seven had jaundice only. Clinical parameters including technical and clinical success rates and complications following TIBS were evaluated. Overall survival and stent occlusion-free survival were assessed using Kaplan-Meier analysis. RESULTS The indications for transjugular approach were massive ascites with (n=2) or without (n=10) coagulopathy. TIBS was technically successful in 11 of 12 patients. Clinical success was defined as successful internal drainage and was achieved in eight patients. The mean serum bilirubin level was initially 13.9±6.3 mg/dL and decreased to 4.9±5.3 mg/dL within 1 month after stent placement (P = 0.037). Two patients had procedure-related complications (hemobilia). During the follow-up period (mean, 30 days; range, 1-146 days), all 12 patients died of disease progression. The median overall survival and stent occlusion-free survival times were 19 days (95% confidence interval [CI], 16-22 days) and 19 days (95% CI, 12-26 days), respectively. There was no stent dysfunction in the eight patients that had successful internal drainage. CONCLUSION TIBS appears to be safe, technically feasible, and clinically effective for patients with malignant biliary obstruction complicated by massive ascites with or without coagulopathy.
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Affiliation(s)
- Dong Jae Shim
- Department of Radiology, Incheon St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Republic of Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Ulsan University School of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, Ulsan University School of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, Ulsan University School of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kyu-Bo Sung
- Department of Radiology and Research Institute of Radiology, Ulsan University School of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Augustin AM, Cao V, Fluck F, Kunz J, Bley T, Kickuth R. Percutaneous transhepatic biliary tract embolization using gelatin sponge. Acta Radiol 2019; 60:1194-1199. [PMID: 30628848 DOI: 10.1177/0284185118820049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Anne Marie Augustin
- Julius-Maximilians-University of Würzburg, Institute of Diagnostic and Interventional Radiology, Würzburg, Germany
| | - Victoria Cao
- Julius-Maximilians-University of Würzburg, Institute of Diagnostic and Interventional Radiology, Würzburg, Germany
| | - Friederika Fluck
- Julius-Maximilians-University of Würzburg, Institute of Diagnostic and Interventional Radiology, Würzburg, Germany
| | - Julian Kunz
- Julius-Maximilians-University of Würzburg, Institute of Diagnostic and Interventional Radiology, Würzburg, Germany
| | - Thorsten Bley
- Julius-Maximilians-University of Würzburg, Institute of Diagnostic and Interventional Radiology, Würzburg, Germany
| | - Ralph Kickuth
- Julius-Maximilians-University of Würzburg, Institute of Diagnostic and Interventional Radiology, Würzburg, Germany
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Transhepatic Tract Embolisation After Biliary Intervention Using n-Butyl Cyanoacrylate and Autologous Blood: A Retrospective Analysis of 42 Patients. Cardiovasc Intervent Radiol 2019; 42:1199-1203. [PMID: 31073822 DOI: 10.1007/s00270-019-02237-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE We evaluated the safety and efficacy of transhepatic tract embolisation after a biliary intervention using n-butyl cyanoacrylate (NBCA) and autologous blood. MATERIALS AND METHODS Between January 2017 and December 2018, 42 consecutive patients (mean age: 71 ± 15 years, 24 men) with malignant (n = 26) or benign (n = 16) biliary obstructions underwent percutaneous biliary intervention followed by tract embolisation within 2 weeks. Forty-six transhepatic tracts (4 bilateral) in 42 patients were embolised using a NBCA and lipiodol mixtures (1:1-1:2 ratios) after intraductal infusion of peripherally obtained autologous blood. The indwelling catheter diameters were 8.5-14 Fr. The median interval between percutaneous biliary drainage and tract embolisation was 10 days (range 3-14 days). Glue-cast formation via fluoroscopy and immediate complications were reviewed retrospectively in medical records. Follow-up data (median: 135, range 11-720 days) including computed tomography (CT) images (n = 17) were evaluated for delayed complications and glue-cast formation. RESULTS Successful glue-cast formations were achieved in all 46 tracts. No patients experienced haemorrhage, and only one patient had external bile leakage. Eight patients complained of abdominal pain (numerical scale ≤ 5) immediately after embolisation, which was controlled by analgesics. Two patients had transient fever. Segmental (n = 11) or sub-segmental (n = 6) glue-cast patterns were identified along the transhepatic tract by follow-up CT. No biliary obstructions were caused by inadvertent glue spread. Fragmented glue was detected outside the stent in one patient. CONCLUSION Transhepatic parenchymal tract embolisation with NBCA and autologous blood is a safe and feasible method for preventing bile leakage. LEVEL OF EVIDENCE Level 4, Case Series.
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Alvarez-Sánchez MV, Luna OB, Oria I, Marchut K, Fumex F, Singier G, Salgado A, Napoléon B. Feasibility and Safety of Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) for Malignant Biliary Obstruction Associated with Ascites: Results of a Pilot Study. J Gastrointest Surg 2018; 22:1213-1220. [PMID: 29532359 DOI: 10.1007/s11605-018-3731-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/26/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND It has been suggested that EUS-BD may be a feasible and safer alternative to percutaneous transhepatic biliary drainage (PTBD) after failed ERCP in patients with ascites. To date, no study has specifically evaluated the performance of EUS-BD in this context. METHODS Retrospective analysis was done for patients with and without ascites who underwent EUS-BD for malignant biliary obstruction after failed ERCP between July 2010 and September 2014. Complications and technical and clinical successes between the two groups were compared. RESULTS A total of 31 patients were included: 20 patients without ascites (group 1) and 11 with ascites (group 2). Nineteen patients underwent EUS-hepaticogastrostomy (six in group 2), and 12 underwent EUS-choledochoduodenostomy (five in group 2). Technical success was achieved in all patients. Clinical success was observed in 95% (n = 19) in group 1 and 64% (n = 7) in group 2 (p = 0.042). In three out of four patients without clinical success in group 2, the follow-up period was not long enough to observe the clinical response because of early death within the 2 weeks after EUS-BD secondary to disease progression or preprocedural unresponsive sepsis. No significant differences were observed between groups 1 and 2 either in the overall rates of procedural-related complications (20 and 9%, respectively, p = 0.63) or in the rates of major complications (15 vs 9%, respectively, p = 0.639). Stent migration occurred in one patient in each group, intra- or post-procedural bleeding occurred in two patients in group 1, which was conservatively managed, and one patient in group 1 presented biliary leakage. Stent patency and the number of re-interventions were not significantly different. CONCLUSIONS EUS-BD is technically feasible in patients with ascites. Our results suggest that EUS-BD may be a clinically effective and safe alternative after failed ERCP in patients with ascites.
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Affiliation(s)
- María Victoria Alvarez-Sánchez
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France.
- Department of Gastroenterology, Complejo Hospitalario de Pontevedra, Pontevedra, Spain.
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Pontevedra, Spain.
| | - O B Luna
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Clinica Echoendo, Rio de Janeiro, Brazil
| | - I Oria
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Department of Gastroenterology, Hospital Italiano, Buenos Aires, Argentina
| | - K Marchut
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Department of Gastroenterology, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - F Fumex
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - G Singier
- Department of Surgery, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - A Salgado
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Pontevedra, Spain
| | - B Napoléon
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
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Demirtaş MM, Cimen S, Ketenci B, Günay R, Akçar M, Özler A. Late Follow-Up of Cyanoacrylate Usage in Cardiothoracic Surgery. Asian Cardiovasc Thorac Ann 2016. [DOI: 10.1177/021849239900700308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In cardiovascular and thoracic surgery, troublesome bleeding and sternal dehiscence can be life-threatening if not managed appropriately. We used commercially available cyanoacrylate adhesive 21 times in 20 sporadic patients for the management of 6 different problems: sternal gluing in 7 cases; anastomotic line reinforcement and bleeding control with a glued Teflon or pericardial patch in 6; right ventricular or superior vena caval patch repair in 5; and 1 case each of left ventricular apical glued Teflon felt, arterial wall reinforcement, and control of air leakage after lung surgery. The mean age of the patients was 55.7 ± 12.5 years, ranging from 34 to 71 years. Successful results were obtained in 18 patients and 17 were alive on follow-up at 7.7 ± 5.5 months (range, 2 to 16 months). We used two different commercial brands of adhesive but obtained good results with only one of these preparations. Although commercially available cyanoacrylate is a new adjunct to cardiac surgery with documented safety and lifesaving results at negligible cost, the appropriate polymer for best results needs to be defined.
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Affiliation(s)
- M Murat Demirtaş
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
| | - Serdar Cimen
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
| | - Bülend Ketenci
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
| | - Rafet Günay
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
| | - Murat Akçar
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
| | - Azmi Özler
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
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Dale AP, Khan R, Mathew A, Hersey NO, Peck R, Lee F, Goode SD. Hepatic Tract Plug-Embolisation After Biliary Stenting. Is It Worthwhile? Cardiovasc Intervent Radiol 2015; 38:1244-51. [PMID: 25762487 DOI: 10.1007/s00270-015-1058-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 01/19/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE PTC and stenting procedures are associated with significant risks including life-threatening haemorrhage, sepsis, renal failure and high mortality rates. PTC tract closure methods are utilised to reduce haemorrhagic complications despite little evidence to support their use. The current study assesses the incidence of haemorrhagic complications following PTC and stenting procedures, both prior to and following the introduction of a dedicated expanding gelatin foam-targeted embolisation liver tract closure technique. MATERIALS AND METHODS Haemorrhagic complications were retrospectively identified in patients undergoing PTC procedures both prior to (subgroup 1) and following (subgroup 2) the introduction of a dedicated targeted liver tract closure method between 9/11/2010 and 10/08/2012 in a single tertiary referral centre. Mean blood Hb decrease following PTC was established in subgroups 1 and 2. Kaplan-Meier life-table analysis was performed to compare survival outcomes between subgroups using the log-rank test. RESULTS Haemorrhagic complications were significantly reduced following the introduction of the targeted PTC tract closure method [(12 vs. 3 % of subgroups 1 (n = 101) and 2 (n = 92), respectively (p = 0.027)]. Mean blood Hb decrease following PTC was 1.40 versus 0.68 g/dL in subgroups 1 and 2, respectively (p = 0.069). 30-day mortality was 14 and 12 % in subgroups 1 and 2, respectively. 50 % of the entire cohort had died by 174 days post-PTC. CONCLUSION Introduction of liver tract embolisation significantly reduced haemorrhagic complications in our patient cohort. Utilisation of this method has the potential to reduce the morbidity and mortality burden associated with post-PTC haemorrhage by preventing bleeding from the liver access tract.
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Affiliation(s)
- Adam P Dale
- Department of Medical Microbiology, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, UK.
| | - Rafeh Khan
- Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Anup Mathew
- Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Naomi O Hersey
- Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Robert Peck
- Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Frederick Lee
- Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Stephen D Goode
- Sheffield Vascular Institute, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
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Park SY, Kim J, Kim BW, Wang HJ, Kim SS, Cheong JY, Cho SW, Won JH. Embolization of percutaneous transhepatic portal venous access tract with N-butyl cyanoacrylate. Br J Radiol 2014; 87:20140347. [PMID: 25027034 PMCID: PMC4453156 DOI: 10.1259/bjr.20140347] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/07/2014] [Accepted: 07/14/2014] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To evaluate the safety and feasibility of N-butyl cyanoacrylate (N-BCA) embolization of percutaneous transhepatic portal venous access tract and to establish an appropriate technique. METHODS 40 consecutive patients underwent percutaneous transhepatic portal venous intervention for various reasons. Embolization of percutaneous transhepatic portal venous access tract was performed after the procedure in all of the patients using N-BCA and Lipiodol® (Lipiodol Ultra Fluide; Laboratoire Guerbet, Aulnay-sous-Bois, France) mixture. Immediate ultrasonography and fluoroscopy were performed to evaluate perihepatic haematoma formation and unintended embolization of more than one segmental portal vein. Follow-up CT was performed, and haemoglobin and haematocrit levels were checked to evaluate the presence of bleeding. RESULTS Immediate haemostasis was achieved in all of the patients, without development of perihepatic haematoma or unintended embolization of more than one segmental portal vein. Complete embolization of percutaneous access tract was confirmed in 39 out of 40 patients by CT. Seven patients showed decreased haemoglobin and haematocrit levels. Other complications included mild pain at the site of embolization and mild fever, which resolved after conservative management. 16 patients died during the follow-up period owing to progression of the underlying disease. CONCLUSION Embolization of percutaneous transhepatic portal vein access tract with N-BCA is feasible and technically safe. With the appropriate technique, N-BCA can be safely used as an alternate embolic material since it is easy to use and inexpensive compared with other embolic materials. ADVANCES IN KNOWLEDGE This is the first study to investigate the efficacy of N-BCA for percutaneous transhepatic portal venous access tract embolization.
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Affiliation(s)
- S Y Park
- 1 Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
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Seif HMA, Zidan M, Helmy A. One-stage percutaneous triple procedure for treatment of endoscopically unmanageable patients with malignant biliary obstruction and marked ascites. Arab J Gastroenterol 2013; 14:148-53. [PMID: 24433643 DOI: 10.1016/j.ajg.2013.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 08/30/2013] [Accepted: 10/07/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND STUDY AIMS To assess the feasibility, safety and efficacy of one-stage percutaneous triple procedure including; ascites drainage, primary metallic biliary stenting, and tract embolisation with N-butyl 2-cyanoacrylate (NBCA), in treatment of patients with malignant biliary obstruction and marked ascites. PATIENTS AND METHODS This study involved 25 patients with malignant biliary obstruction and marked ascites (age range, 46-78y; mean age±SD, 65y±5) for whom endoscopic treatment failed or was unsuitable. Ascites drainage, percutaneous primary metallic biliary stenting, and tract embolisation with lipiodol/NBCA mixture were performed in a one-stage procedure. The mean±SD follow up period was 26±2weeks. RESULTS The technical and clinical success rates were 96% and 88% respectively. No procedure related deaths or major complications were observed. The reported minor complications included; moderate pain and vomiting during and after balloon dilation, postprocedural cholangitis, and bile leakage in 44%, 16%, and 8% of the patients respectively. Primary stent patency was achieved in 96%. The 30-days mortality was 8%. The stent obstruction occurred in 3 (13%) of the 23 patients who survived more than 30-days. CONCLUSIONS Percutaneous drainage of ascites followed immediately by primary biliary stenting, together with tract embolisation with NBCA is technically feasible, safe, and effective alternative palliative treatment for endoscopically unmanageable patients with malignant biliary obstruction and marked ascites.
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Affiliation(s)
- Hany M A Seif
- Department of Radiology, Assiut University Hospital & Faculty of Medicine, Assiut 71517, Egypt.
| | - Mohammed Zidan
- Department of Radiology, Assiut University Hospital & Faculty of Medicine, Assiut 71517, Egypt
| | - Ahmed Helmy
- Department of Tropical Medicine & Gastroenterology, Assiut University Hospital & Faculty of Medicine, Assiut 71517, Egypt
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Saad WEA, Madoff DC. Percutaneous portal vein access and transhepatic tract hemostasis. Semin Intervent Radiol 2013; 29:71-80. [PMID: 23729976 DOI: 10.1055/s-0032-1312567] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Percutaneous portal vein interventions require minimally invasive access to the portal venous system. Common approaches to the portal vein include transjugular hepatic vein to portal vein access and direct transhepatic portal vein access. A major concern of the transhepatic route is the risk of postprocedural bleeding, which is increased when patients are anticoagulated or receiving pharmaceutical thrombolytic therapy. Thus percutaneous portal vein access and subsequent closure are important technical parts of percutaneous portal vein procedures. At present, various techniques have been used for either portal access or subsequent transhepatic tract closure and hemostasis. Regardless of the method used, meticulous technique is required to achieve the overall safety and effectiveness of portal venous procedures. This article reviews the various techniques of percutaneous transhepatic portal vein access and the various closure and hemostatic methods used to reduce the risk of postprocedural bleeding.
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Affiliation(s)
- Wael E A Saad
- Division of Vascular Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
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Sofue K, Arai Y, Takeuchi Y, Fujiwara H, Tokue H, Sugimura K. Safety and efficacy of primary metallic biliary stent placement with tract embolization in patients with massive ascites: a retrospective analysis of 16 patients. J Vasc Interv Radiol 2012; 23:521-7. [PMID: 22464717 DOI: 10.1016/j.jvir.2012.01.073] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 01/15/2012] [Accepted: 01/20/2012] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of primary metallic biliary stent placement with tract embolization in patients with massive ascites. MATERIALS AND METHODS Sixteen patients with malignant biliary obstruction and massive ascites (age range, 44-79 y; median age, 59 y) were treated with primary percutaneous stent placement with tract embolization. These patients were unsuitable candidates for endoscopic intervention. Etiologies of biliary obstruction were gastric cancer with hilar nodal metastases (n = 9), pancreatic carcinoma (n = 5), cholangiocarcinoma (n = 1), and gallbladder carcinoma (n = 1). Eight patients had nonhilar lesions and the remaining eight had hilar lesions. Percutaneous accesses to the biliary system and stent placements were performed in a one-step procedure, and catheters were removed with tract embolization with metallic coils. RESULTS Stent placement and tract embolization were successful in all patients, without external drainage catheters left in place. Significant reduction of serum bilirubin level was observed in 14 patients (87.5%). No bile peritonitis or intraperitoneal hemorrhage occurred. Major complications included postprocedural cholangitis (12.5%), bloody bowel discharge (6.2%), and right pleural effusion (25.0%). One patient who died 19 days after intervention was deemed to represent a procedure-related mortality. During the survival period (range, 19-175 d; median, 66 d), stent occlusion was noted in two patients at 6 and 159 days after the procedure. Primary stent patency was achieved in 14 patients (87.5%). CONCLUSIONS Primary biliary stent placement with tract embolization is technically safe and offers an effective palliative treatment option for patients with malignant biliary obstruction and massive ascites when endoscopic intervention is not possible.
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Affiliation(s)
- Keitaro Sofue
- Division of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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Canyigit M, Gumus M, Cay N, Erol B, Karaoglanoglu M, Akhan O. Refractory cystobiliary fistula secondary to percutaneous treatment of hydatid cyst: treatment with N-butyl 2-cyanoacrylate embolization. Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S266-70. [PMID: 20054546 DOI: 10.1007/s00270-009-9790-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 12/17/2009] [Indexed: 11/24/2022]
Abstract
A 27-year-old female with a type 2 hydatid cystic lesion in the liver according to the Gharbi classification (CE 3A according to the WHO classification) was referred for percutaneous treatment after albendazole treatment for 1 year. A catheterization technique was performed but hypertonic saline and alcohol were not given into the cavity due to cystobiliary leakage. During the 4-month follow-up period, sequential cavitography revealed biliary fistula, and bile-stained drainage had not been ceased despite the sphincterotomy, nasobiliary drainage catheter, and plastic stent. Since the patient refused to surgery, we embolized the biliary fistula using N-butyl 2-cyanoacrylate for the first time in the literature. At the 3-month follow-up, the patient's course was uneventful and ultrasound, multidetector-row CT, and MRI examinations revealed no collection in or adjacent to the cavity.
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Affiliation(s)
- Murat Canyigit
- Department of Radiology, Ankara Ataturk Education and Research Hospital, Bilkent, 06800 Ankara, Turkey.
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