Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Diagn Interv Imaging. 2018 Nov;99(11):717-724. doi: 10.1016/j.diii.2018.06.006. Epub 2018 Jul 20.
The purpose of this study was to report the incidence of massive bleeding after endoscopic ultrasound-guided transmural pancreaticobiliary drainage (EUS-TPBD) and the clinical outcomes in patients with this condition treated with transcatheter arterial embolization (TAE).
We performed a 9-year retrospective analysis of 797 EUS-TPBD procedures (excluding gallbladder or pseudocysts) in 729 patients. Among them, twelve (12/729, 1.65%) patients were referred for TAE to manage active bleeding adjacent to the TPBD sites. There were 8 men and 4 women with a mean age of 66.1 years±13.4 (SD) (range: 45-89 years). The clinical and procedure data of these 12 patients were reviewed.
Thirteen TAE procedures in 12 patients were performed. The bleeding sites were the left hepatic artery (n=7), the right hepatic artery (n=3), the left gastric artery (n=1), the left accessory gastric artery (n=1) and gastroduodenal artery (n=1). TAE was performed with gelatin sponge particles (n=1), coil (n=1) and n-butyl-2 cyanoacrylate with/without coils (n=11), with technical and clinical success rates of 100% (13/13) and 85% (11/13), respectively. Re-bleeding following embolization with gelatin sponge particles occurred in one patient. Procedure-related ischemic hepatitis was observed in another patient with pancreatic cancer with portal vein involvement.
On the basis of our results, TAE using n-butyl-2 cyanoacrylate seems safe and effective for the treatment of bleeding after EUS-TPBD procedures. When the portal vein is compromised, TAE of the hepatic artery can cause ischemic liver damage.
本研究旨在报告内镜超声引导下经壁胰腺胆道引流（EUS-TPBD）后大出血的发生率，并报道经导管动脉栓塞（TAE）治疗该并发症患者的临床结局。
我们对 729 例患者的 797 例 EUS-TPBD 操作（不包括胆囊或假性囊肿）进行了 9 年的回顾性分析。其中，12 例（12/729，1.65%）患者因靠近 TPBD 部位的活动性出血而转介行 TAE 治疗。患者中有 8 名男性和 4 名女性，平均年龄为 66.1 岁±13.4（SD）（范围：45-89 岁）。回顾分析了这 12 例患者的临床和手术数据。
12 例患者共进行了 13 次 TAE 手术。出血部位为左肝动脉（n=7）、右肝动脉（n=3）、胃左动脉（n=1）、左胃网膜动脉（n=1）和胃十二指肠动脉（n=1）。TAE 采用明胶海绵颗粒（n=1）、弹簧圈（n=1）和 n-丁基-2 氰基丙烯酸酯联合/不联合弹簧圈（n=11），技术成功率和临床成功率分别为 100%（13/13）和 85%（11/13）。1 例患者在栓塞明胶海绵颗粒后再次出血。1 例合并门静脉受累的胰腺癌患者在 TAE 后出现与操作相关的缺血性肝炎。
根据我们的结果，n-丁基-2 氰基丙烯酸酯的 TAE 似乎是治疗 EUS-TPBD 术后出血的安全有效方法。当门静脉受累时，肝动脉 TAE 可能会导致肝脏缺血性损伤。
