Francisco Javier Bueno Recio1, Josep Ramón Armengol Miró2, Mercedes Pérez Lafuente3, John Alexander Camacho Oviedo4, Iratxe Díez Miranda4, Alejandro Tomasello5, Joan Dot Bach2, Jordi Armengol Bertroli2, Laura Ludovica Gramegna6, José Andrés Molino Gahete1. 1. Pediatric Surgery Department, Hospital Vall d'Hebron, Passeig de la Vall d´Hebron 119-129, 08035, Barcelona, Spain. 2. Digestive Endoscopy Department, WIDER (World Institute for Digestive Endoscopy), Hospital Vall d'Hebron, Passeig de la Vall d´Hebron 119-129, 08035, Barcelona, Spain. 3. Department of Interventional Radiology, Hospital Vall d'Hebron, Passeig de la Vall d´Hebron 119-129, 08035, Barcelona, Spain. mperez@vhebron.net. 4. Department of Interventional Radiology, Hospital Vall d'Hebron, Passeig de la Vall d´Hebron 119-129, 08035, Barcelona, Spain. 5. Interventional Neuroradiology Section, Department of Radiology, Hospital Vall d'Hebron, Passeig de la Vall d´Hebron 119-129, 08035, Barcelona, Spain. 6. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
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.
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.