Main Bile Duct Stricture Occurring After Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

Abstract

The purpose of this study was to evaluate the clinical course of main bile duct stricture at the hepatic hilum after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Among 446 consecutive patients with HCC treated by TACE, main bile duct stricture developed in 18 (4.0%). All imaging and laboratory data, treatment course, and outcomes were retrospectively analyzed. All patients had 1 to 2 tumors measuring 10 to 100 mm in diameter (mean ± SD 24.5 ± 5.4 mm) near the hepatic hilum fed by the caudate arterial branch (A1) and/or medial segmental artery (A4) of the liver. During the TACE procedure that caused bile duct injury, A1 was embolized in 8, A4 was embolized in 5, and both were embolized in 5 patients. Nine patients (50.0%) had a history of TACE in either A1 or A4. Iodized oil accumulation in the bile duct wall was seen in all patients on computed tomography obtained 1 week later. Bile duct dilatation caused by main bile duct stricture developed in both lobes (n = 9), in the right lobe (n = 3), in the left lobe (n = 4), in segment (S) 2 (n = 1), and in S3 (n = 1). Serum levels of alkaline phosphatase and γ-glutamyltranspeptidase increased in 13 patients. Biloma requiring drainage developed in 2 patients; jaundice developed in 4 patients; and metallic stents were placed in 3 patients. Complications after additional TACE sessions, including biloma (n = 3) and/or jaundice (n = 5), occurred in 7 patients and were treated by additional intervention, including metallic stent placement in 2 patients. After initial TACE of A1 and/or A4, 8 patients (44.4%), including 5 with uncontrollable jaundice or cholangitis, died at 37.9 ± 34.9 months after TACE, and 10 (55.6%) have survived for 38.4 ± 37.9 months. Selective TACE of A1 and/or A4 carries a risk of main bile duct stricture at the hepatic hilum. Biloma and jaundice are serious complications associated with bile duct strictures.

Phase II Study of Chemoembolization With Drug-Eluting Beads in Patients With Hepatic Neuroendocrine Metastases: High Incidence of Biliary Injury

“…Numerous reports discuss biliary necrosis and biloma formation after conventional lipiodol-based transarterial chemoembolization (c-TACE) [28–31]. In the largest series of 972 patients, 35 patients (3.6 %) developed intrahepatic bilomas after TACE treatment.…”

Hepatocellular carcinoma in the caudate lobe of the liver: variations of its feeding branches on arteriography

“…[12][13][14] When the embolic materials are injected from one of the caudate arteries, c CT 1 week after TACE shows dense iodized oil accumulation in the tumor. d CT 6 years after TACE shows that the tumor was well controlled.…”

“…7). [12][13][14] Hepatocellular carcinoma HCC in the Spiegel lobe HCC located in the Spiegel lobe is usually fed by the caudate arteries derived from the right and/or left hepatic artery. 5,6 Almost all feeding branches mainly arise from the proximal portion of the right and left hepatic artery (Figs.…”

Long-Term Outcome of Transcatheter Subsegmental and Segmental Arterial Chemoemobolization Using Lipiodol for Hepatocellular Carcinoma

“…Subseg/seg lip-TACE was also applicable even to patients with HCC who needed to be treated with a combination of TACE and transjugular intrahepatic portosystemic shunt for their esophagogastric varices because of its minimum adverse effects to hepatic functional reserves [44]. Because uncommon bile duct stricture occurring after TACE has been reported [45], and because we have also experienced a case associated with partial bile duct dilatation without symptoms after subseg/ seg lip-TACE, relatively mild subseg/seg lip-TACE suitable for each individual patient is recommended. Postembolization fever (PEF), defined as a body temperature[38°C after chemoembolization in patients with HCC, correlates strongly with large tumor size and develops in only 4.8% of patients with tumor size \5 cm, which is significantly lower than in patients with tumor size [5 cm [41].…”