title: Risk of liver abscess formation in patients with prior biliary intervention following yttrium-90 radioembolization.
abstract: OBJECTIVE
  Patients without a competent sphincter of Oddi due to prior surgical or endoscopic therapy are at high risk for liver abscess following chemoembolization despite aggressive antimicrobial prophylaxis. We examined a cohort of such patients undergoing Y-90 resin radioembolization and compared them to a cohort of chemoembolized patients.
  
  
  METHODS
  Review of our quality-assurance database identified 24 radioembolizations performed in 16 patients with prior biliary intervention. An aggressive prophylactic regimen of oral levofloxacin and metronidazole 2 days pre-procedure continuing for 14 days after, oral neomycin/erythromycin bowel prep the day before, and IV levofloxacin/metronidazole the day of treatment was prescribed. Patients underwent resin microsphere radioembolization dosed according to the BSA method. Patients had clinical, imaging, and laboratory assessment 1 month after each treatment, and then every 3 months. The chemoembolization cohort consisted of 13 patients with prior biliary intervention who had undergone 24 chemoembolization procedures.
  
  
  RESULTS
  No radioembolization patient developed an abscess. In the cohort of chemoembolized patients who received the same prophylaxis, liver abscess occurred following 3 of 24 (12.5 %) procedures in 3 of 13 (23 %) patients, one fatal.
  
  
  CONCLUSIONS
  This preliminary experience suggests that the risk of liver abscess among patients with prior biliary intervention may be lower following radioembolization than chemoembolization, which could potentially expand treatment options in this high-risk population.
authors.affiliation: Division of Interventional Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
authors.forename: Aurada
authors.initials: A
authors.lastname: Cholapranee
authors.forename: Diana
authors.initials: D
authors.lastname: van Houten
authors.forename: Ginna
authors.initials: G
authors.lastname: Deitrick
authors.forename: Mandeep
authors.initials: M
authors.lastname: Dagli
authors.forename: Deepak
authors.initials: D
authors.lastname: Sudheendra
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mondschein
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008100:Liver Abscess / Q000209:etiology*; D008113:Liver Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000009:adverse effects; D012307:Risk Factors; D015021:Yttrium Radioisotopes / Q000009:adverse effects
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes