Percutaneous interventional therapy of persistent biliary fistulas.
BACKGROUND
Persistent biliary leakage is a challenging problem when conservative treatment methods fail. We present our experience with alternative percutaneous radiologic interventions to seal refractory biliary leaks.


METHODS
From April 1998 to December 2005, a retrospective analysis of 23 patients with biliary leakage revealed six patients who were unresponsive to drainage were treated with use of Histoacryl (n = 5), microcoils (n = 2), or covered stent (n = 2) alone or in various combinations.


RESULTS
In all patients, the biliary leakage ceased following a single procedure. Distally migration of microcoils into the abscess cavity was observed in a one coiling procedure, which was clinically insignificant. In one patient treated with covered stent, in-stent restenosis was seen in the postprocedural second year, which required another intervention. No recurrence of fistula was noted in the follow-up period (ranging from 6 to 47 months).


CONCLUSIONS
Persistent biliary fistulas can be treated successfully by means of various percutaneous radiological interventions that can decrease the morbidity associated with prolonged external drainage and avert the need for surgery. We recommend superselective embolization, preferably with Histoacryl, for a safe and effective control of leakage. Although restenosis after stenting remains problematic, covered stents should be reserved as a feasible alternative for selected cases.
Yagci
Baki
B
Department of Radiology, Pamukkale University Hospital, Denizli, Turkey. bakiyagci@yahoo.com
Parildar
Mustafa
M
Oran
Ismail
I
Memis
Ahmet
A
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D001658:Biliary Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D003287:Contrast Media; D004322:Drainage; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D004659:Enbucrilate