Persistent Cystic Duct Stump Leak Managed with Hydrocoil Embolization

Doshi, Taral; Mojtahedi, Alireza; Goswami, Gaurav; Andrews, Robert T.; Godke, Bhasvaraj; Valji, Karim

doi:10.1007/s00270-008-9431-4

Cited by 11 publications

(9 citation statements)

References 12 publications

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“…Several different interventional approaches have been proposed for the minimally invasive treatment of biliary leaks. The main materials that have been studied as potential sealants of the biliary ducts are fibrin [21], ethanol [22], glue [23], covered stents [24], vascular plugs [25] and coils [26]. Although most of the abovementioned techniques have several drawbacks [21,27], they are still employed, as there is a lack of dedicated techniques/devices enabling technically simple and efficient occlusion, especially of larger biliary leaks [17].…”

Section: Discussionmentioning

confidence: 99%

“…Vascular plugs and coils can only achieve total biliary occlusion when combined with glue or fibrin, as the biliary system has no inherent clotting capabilities. Although hydrocoils have been successfully used to occlude biliary leaks [26], the risk of malconfiguration with consecutive over-embolization persists. Covered stents carry a risk of unintentional occlusion of adjacent biliary ducts and post-interventional cholangitis [29].…”

Section: Discussionmentioning

confidence: 99%

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Ex Vivo Evaluation of the ArtVentive EOS Occlusion Device for the Management of Biliary Leaks

Kuetting¹,

Schild²,

Pieper³

2018

Fortschr Röntgenstr

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Purpose Percutaneous treatment of biliary leaks is frequently required, yet technically challenging and limited to smaller fistulas. This study sought to evaluate the off-the-shelf use of the ArtVentive EOS device for the occlusion of biliary or cystic stump leaks. Materials and Methods ePTFE-covered ArtVentive EOS devices were used to perform biliary leak embolization in 5 explanted porcine livers and in 3 explanted bovine livers. After establishing standard percutaneous transhepatic biliary drainage access, artificially created biliary leaks were occluded using 5 & 8 mm EOS devices. Using the 5 mm device, peripheral (n = 3), central (n = 1) and cystic duct leaks (n = 1) were occluded. Using the 8 mm device, peripheral (n = 1), central (n = 1), main (n = 1) and cystic duct leaks (n = 2) were occluded. Total leak occlusion was controlled by cholangiography. Results Selective deployment and occlusion of central biliary leaks (3/3) and cystic stump leaks (3/3) was successful in all cases. Peripheral leaks could not be selectively catheterized in 3 out of 4 cases, making device deployment several millimeters proximal to the leaks necessary. Conclusion Selective occlusion of the cystic stump, central biliary, and larger peripheral biliary leaks using the EOS device is technically feasible ex-vivo in a single setting. Key points Citation Format

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ex Vivo Evaluation of the ArtVentive EOS Occlusion Device for the Management of Biliary Leaks

Kuetting¹,

Schild²,

Pieper³

2018

Fortschr Röntgenstr

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“…Combination of cyanoacrylate glue and angiographic coils has also been deployed via endoscope at ERCP to resolve cystic duct leak after failed operations [ 8 ]. Percutaneous trans hepatic deployment of Hydrocoil into the cystic duct stump has been reported as well [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Persistent Postcholecystectomy Bile Leak Using Percutaneous Cystic Duct Coiling

Rai

Beckley

Fabre

et al. 2015

Case Reports in Surgery

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Laparoscopic cholecystectomy is one of the most commonly performed operations worldwide. Cystic duct is the most common site of bile leak after cholecystectomy. The treatment of choice is usually conservative. Using sufficient percutaneous drainage of the biloma cavity and endoscopic retrograde cholangiography (ERCP) with sphincterotomy and/or stenting, the cure rate of bile leaks is greater than 90%. In very rare cases, all of these measures remain unsuccessful. We report a technique for the successful treatment of persistent cystic duct leak. After failed ERCP and stenting, bile leak was treated by coiling the cystic duct through a drain tract. This technique is safe and effective and helps avoid the morbidity of reoperation.

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“…Oliva et al 18 and Hunt et al 19 described percutaneous management of biliary fistula using metallic coil embolization. The percutaneous use of hydrocoil to manage cystic duct stump leak is described by Doshi et al 20 Hydrocoils have the advantage of swelling or expansion when the hydrophilic polymer comes into contact with fluids.…”

Section: Discussionmentioning

confidence: 99%

A novel endoscopic treatment of major bile duct leak

Wahaibi

Al-Naamani

Alkindi

et al. 2014

International Journal of Surgery Case Reports

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INTRODUCTIONBile leak is a serious complication of hepatobiliary surgery. The incidence has remained the same over the last decade despite significant improvement in the results of liver surgery.PRESENTATION OF CASEA 21-year-old man was a passenger in a motor vehicle and sustained a blunt abdominal trauma in a high-speed collision leading to major liver laceration. He had right lobe hepatectomy complicated by major bile leak. He was not fit for further surgery and he, therefore, had ERCP and obliteration of the leaking bile duct using a combination of metallic coil and N-butyl cyanoacrylate.DISCUSSIONEndoscopic therapy has become the modality of choice in the treatment of biliary tract injuries. Different modalities of management of persistent bile leak such as sphincterotomy, plastic biliary stents, and nasobiliary drainage have been described. Obliteration of bile duct leak using N-butyl cyanoacrylate and coil embolization has been described but most of these reports used the percutaneous transhepatic approach.CONCLUSIONIn this paper, we describe the second reported case in English literature of a novel endoscopic technique using a combination of metallic coil embolization and N-butyl cyanoacrylate in a patient with major bile leak who was not a candidate for surgery as well as a third report of the late complication of coil migration to the common bile duct.

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Persistent Cystic Duct Stump Leak Managed with Hydrocoil Embolization

Cited by 11 publications

References 12 publications

Ex Vivo Evaluation of the ArtVentive EOS Occlusion Device for the Management of Biliary Leaks

Ex Vivo Evaluation of the ArtVentive EOS Occlusion Device for the Management of Biliary Leaks

Successful Treatment of Persistent Postcholecystectomy Bile Leak Using Percutaneous Cystic Duct Coiling

A novel endoscopic treatment of major bile duct leak

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