Pancreatic tissue damage by transcatheter arterial embolization for hepatoma

Abstract

We analyzed the serial changes in serum pancreatic enzyme activities by transcatheter arterial embolization (TAE) in 20 hepatoma patients with liver cirrhosis in an attempt to evaluate the incidence of the pancreatic tissue damage by TAE. Serum amylase activities increased in two (10%) cases, elastase 1 levels in six (30%) cases, and trypsin and pancreatic secretory trypsin inhibitor (PSTI) levels in each of five (25%) cases. Consequently, TAE resulted in the elevation of at least more than one serum pancreatic enzyme in eight (40%) of 20 cases, although none had clinical symptoms related to pancreatitis. When the adverse effect on the pancreatic tissue was compared among 6 cases of the superselective TAE and 14 cases of the nonsuperselective TAE, which were performed from the segmental and the nonsegmental hepatic arteries, respectively, the elevation of serum pancreatic enzymes was caused only by nonsuperselective TAE, not by superselective TAE. The volumes of Spongel and Lipiodol used or the injected doses of the anticancer agent mitomycin C were not different between the two groups. These results indicate that TAE for the treatment of hepatoma frequently causes pancreatic tissue damage, and the position of the inserted catheter tip is very important to avoid the pancreatic tissue damage by TAE.

Acute Pancreatitis after Embolization of Liver Tumors: Frequency and Associated Risk Factors

“…Because many cases of mild pancreatitis after embolization are undiagnosed due to a lack of clinical symp- toms, the results of Khan et al [4] are very illustrative. The serial changes in serum pancreatic enzyme activity were analyzed in 20 hepatoma patients with liver cirrhosis in an attempt to evaluate the incidence of pancreatic tissue damage by TACE.…”

“…For example, one large meta-analysis described acute cholecystitis and ischemic hepatitis as the most frequent complications after bland LE; in patients who underwent TACE, cholecystitis and leukopenia where the most frequent complications [3] . Multiple other complications after LE haven been described, such as pulmonary thromboembolism, hepatic infarct, liver abscess, liver failure, ischemic biliary strictures and less frequently pancreatic damage [4] .…”

Acute necrotizing pancreatitis after transarterial chemoembolization of hepatocellular carcinoma: an usual complication

“…Unusual complications may develop, such as noted by Xia Jinglin et al in their study of 1,348 patients, with an incidence of rare complications of 2.68% that ranged from spontaneous carcinoma rupture to hepatic artery occlusion (0.15 % and 1.99 %); the fact stands out that no acute necrotizing pancreatitis cases was identified in this large series (2). This is an uncommon condition, and studies estimate an incidence of 1.7-2 % (clinical pancreatitis) as compared to 40 % for biological pancreatitis, defined as hyperamylasemia with no clinical impact (3)(4)(5). This complication results from a retrograde injection of the chemotherapeutic, embolizing agent into pancreatic arteries, giving rise to ischemic pancreatitis (6).…”

Clinical impact of selective transarterial chemoembolization on hepatocellular carcinoma: A cohort study

“…Although the possible impairment of liver function is a critical point when assessing TACE feasibility, only a few studies (which are not recent) were adequately reported, evaluating the effects of non-selective TACE on hepatic function [20][21][22][23] . Furthermore, to the best of our knowledge, there are no extensive published data on the short and long term clinical impact of selective TACE in HCC patients.…”