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Percutaneous or Endoscopic Treatment of Peripheral Bile Duct Leaks: Initial Experience with an Innovative Approach of Microcatheter-Delivered Argon Plasma Coagulation

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  • Biliary
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Abstract

Purpose

Biliary ductal injuries are challenging to treat, and often lead to severe morbidity and mortality. The first-line approach involves endoscopic retrograde cholangiopancreatography with sphincterotomy and, in case of refractory leakage, long-lasting percutaneous transhepatic biliary drainage, endoscopic or percutaneous injection of sclerosing agents and/or coiling can be used. We describe a treatment procedure using microcatheter-mediated percutaneous or endoscopic argon plasma coagulation (APC).

Materials and Methods

Three patients (7-year-old male, 14-year-old male, 81-year-old female) with refractory postsurgical and/or post-traumatic bile leaks underwent percutaneous (n = 2) or endoscopic (n = 1) APC through a detachable microcatheter.

Results

The procedure was technically feasible in all patients. Postoperative imaging showed complete occlusion of biliary leakage. The technique was uneventful intraoperatively with no adverse events occurring during recovery or follow-up.

Conclusion

Our initial experience demonstrates that refractory bile duct leaks may be successfully treated with microcatheter-mediated APC endoscopically or percutaneously. Further research is needed to confirm the safety, efficacy, and clinical indications for this innovative technique.

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Acknowledgements

We acknowledge Superior Medical Experts for their assistance with editing.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author information

Author notes

  1. Francisco Javier Bueno Recio and Josep Ramón Armengol-Miró jointly supervised this work.

Authors and Affiliations

  1. Department of Interventional Radiology, Hospital Vall d’Hebron, Passeig de la Vall d´Hebron 119-129, 08035, Barcelona, Spain

    Mercedes Pérez Lafuente, John Alexander Camacho Oviedo & Iratxe Díez Miranda

  2. Interventional Neuroradiology Section, Department of Radiology, Hospital Vall d’Hebron, Passeig de la Vall d´Hebron 119-129, 08035, Barcelona, Spain

    Alejandro Tomasello

  3. Digestive Endoscopy Department, WIDER (World Institute for Digestive Endoscopy), Hospital Vall d’Hebron, Passeig de la Vall d´Hebron 119-129, 08035, Barcelona, Spain

    Joan Dot Bach, Jordi Armengol Bertroli & Josep Ramón Armengol Miró

  4. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy

    Laura Ludovica Gramegna

  5. Pediatric Surgery Department, Hospital Vall d’Hebron, Passeig de la Vall d´Hebron 119-129, 08035, Barcelona, Spain

    José Andrés Molino Gahete & Francisco Javier Bueno Recio

Authors
  1. Mercedes Pérez Lafuente
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  2. John Alexander Camacho Oviedo
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  3. Iratxe Díez Miranda
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  4. Alejandro Tomasello
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  5. Joan Dot Bach
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  6. Jordi Armengol Bertroli
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  7. Laura Ludovica Gramegna
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  8. José Andrés Molino Gahete
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  9. Francisco Javier Bueno Recio
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  10. Josep Ramón Armengol Miró
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Contributions

Conceptualization: Mercedes Pérez Lafuente (mperez@vhebron.net), Francisco Javier Bueno Recio (fjbuenorecio@gmail.com), Josep Ramón Armengol-Miró (jrarmengol@gmail.com). Methodology: Mercedes Pérez Lafuente, John Alexander Camacho Oviedo (j.camacho@vhebron.net), Laura Ludovica Gramegna (lauraludovica.gramegna@unibo.it), Alejandro Tomasello (alejandrotomasello@gmail.com). Formal analysis and Investigation: John Alexander Camacho Oviedo, Iratxe Díez Miranda (idiez@vhebron.net), Joan Dot Bach (jdot@vhebron.net), Jordi Armengol Bertroli (jordiarmengolbertroli@gmail.com), José Andrés Molino Gahete (jamolino@vhebron.net). Writing—original draft preparation: MPL, JACO, LLG. Writing—review and Editing: MPL, JACO, IDM, AT, JDB, JAB, LLG, JAMG, FJBR and JRA-M. Supervision: Francisco JBR and JRA-M.

Corresponding author

Correspondence to Mercedes Pérez Lafuente.

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The authors declare that they have no conflict of interest. The authors report no conflict.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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This study has obtained IRB approval from PR(AG)550.

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Consent for publication was obtained for every individual person’s data included in the study.

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Pérez Lafuente, M., Camacho Oviedo, J.A., Díez Miranda, I. et al. Percutaneous or Endoscopic Treatment of Peripheral Bile Duct Leaks: Initial Experience with an Innovative Approach of Microcatheter-Delivered Argon Plasma Coagulation. Cardiovasc Intervent Radiol 45, 365–370 (2022). https://doi.org/10.1007/s00270-021-03016-8

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  • DOI: https://doi.org/10.1007/s00270-021-03016-8

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