Percutaneous interventional therapy of persistent biliary fistulas

Area of Science:

• Interventional Radiology
• Gastroenterology
• Hepatobiliary Surgery

Background:

• Persistent biliary leakage poses a significant clinical challenge, especially when conservative treatments are ineffective.
• Refractory biliary leaks often require advanced interventions to prevent complications.

Purpose of the Study:

• To evaluate the efficacy of percutaneous radiologic interventions for treating persistent biliary leaks.
• To assess alternative minimally invasive techniques for sealing refractory biliary fistulas.

Main Methods:

• Retrospective analysis of 23 patients with biliary leakage from April 1998 to December 2005.
• Six patients unresponsive to drainage were treated with Histoacryl, microcoils, or covered stents, alone or in combination.

Main Results:

• All patients achieved cessation of biliary leakage after a single procedure.
• Minor complications included microcoil migration (clinically insignificant) and in-stent restenosis after covered stent placement, requiring re-intervention.
• No recurrence of fistula was observed during follow-up (6-47 months).

Conclusions:

• Percutaneous radiological interventions provide successful treatment for persistent biliary fistulas, reducing morbidity and avoiding surgery.
• Superselective embolization, particularly with Histoacryl, is recommended for safe and effective leakage control.
• Covered stents are a feasible alternative for select cases, despite the risk of restenosis.