Abstract
Preventive transhepatic tract embolisation (PTTE) after percutaneous biliary intervention (PBI) may reduce adverse events. The aim of this systematic review was to analyse feasibility, safety, and efficacy of PTTE with different embolic agents. A systematic literature research was performed according to the PRISMA guidelines. The identified studies were analysed concerning study quality, number of cases, indication, embolic agent, embolisation technique, success, and embolisation-related adverse events. Out of 62 identified records, 7 studies of mainly moderate study quality published through 2019 were included for further analysis. Cyanoacrylate (n = 4), gelatin sponge (n = 2), and coils (n = 1) were used as embolic agents in a total number of 314 patients. Technical success was 96–100%. Embolisation-related adverse events (glue migration, pain) occurred in 10/314 (3.2%) patients. Reduction of PBI-related pain was approved by one controlled study; haemorrhage events were reduced but not clearly significant. Overall, biliary leak, transhepatic bleeding, and PBI-related pain occurred in 7/201 (3.5%), 1/293 (0.3%), and 17/46 (36.9%) documented patients after PTTE. Adverse events which likely could not have been prevented by PTTE occurred in 23/180 (12.8%) patients. Embolic agents were not compared. In conclusion, PTTE is feasible and safe. It is effective concerning the prevention of PBI-related pain, and it may be effective concerning haemorrhage. Prevention of biliary leak is not proven. It remains unclear which embolic agent should be preferred. A prospective randomised trial including all preventable adverse events is lacking.
Highlights
Percutaneous biliary intervention (PBI) can be associated with high rates of different adverse events [1, 2], which can be reduced by the use of an ultrasound-guided percutaneous bile duct access [3], stent insertion in a single session without remaining external catheter [4], or left-sided bile duct access [5]
It is effective concerning the prevention of percutaneous biliary intervention (PBI)-related pain, and it may be effective concerning haemorrhage
It was first applied in patients with high bleeding risk after liver biopsy [6]. It was introduced in patients after PBI [7]. It is not well known which adverse events can be prevented by transhepatic tract embolisation, which embolic agent should be preferred, and whether Preventive transhepatic tract embolisation (PTTE) itself is related to adverse events
Summary
Percutaneous biliary intervention (PBI) can be associated with high rates of different adverse events [1, 2], which can be reduced by the use of an ultrasound-guided percutaneous bile duct access [3], stent insertion in a single session without remaining external catheter [4], or left-sided bile duct access [5]. Preventive transhepatic tract embolisation (PTTE) (Figure 1) might be a further effective measure to reduce adverse events after PBI. It was first applied in patients with high bleeding risk after liver biopsy [6]. Hereafter, it was introduced in patients after PBI [7]. It was introduced in patients after PBI [7] It is not well known which adverse events can be prevented by transhepatic tract embolisation, which embolic agent should be preferred, and whether PTTE itself is related to adverse events. A recently published meta-analysis has concluded that EUS-BD may be preferred over percutaneous transhepatic biliary drainage (PTBD) as EUS-BD is Canadian Journal of Gastroenterology and Hepatology (a)
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