Abstract No. 698 Percutaneous embosclerosis for management of biliary leaks

Abstract

Management of biliary leaks are complex and usually require prolonged diversion using drainage catheters. For the patient, and treating interventionalists/surgeons, this is a very frustrating process with uncertain endpoint. For refractory biliary leak cases, we evaluated the potential use of biliary leak embolization using the liquid embolic Onyx® (Covidean, Minneapolis, Minnesota), shortly after initial diversion. Three cases in which patients had bile duct injuries intervened upon using liquid embolization were reviewed. The cases were evaluated for: time to embolization attempt after initial diversion, findings on subsequent follow-up cholangiogram, and findings on outpatient patient evaluation after all catheters were removed. 3 cases were reviewed from two institutions, with 1 biliary leak secondary to hepatic hemangioma percutaneous ablation, 1 secondary to a gunshot wound complication, and 1 which was secondary to was due gastric cancer resection. All three cases involved initial internal-external biliary drainage catheter diversion, and in one case, a biloma drain was also placed. On subsequent cholangiograms (range: 2 days-2 weeks later), each case had a single attempt at microcatheter cannulation of biliary tract leak, and embolization with liquid Onyx®. In 3 of 3 cases (100%), there was complete bile leak cessation at the time of follow up cholangiogram, resulting in drainage catheter removal, and no complications or recurrence on clinical follow up. Biliary leak embolization with Onyx® is feasible and safe for early treatment of biliary leaks early after catheter based diversion.