Iatrogenic Complications and Management of Biliary Interventions

Abstract

Iatrogenic complications can result from both diagnostic and therapeutic hepatobiliary interventions such as percutaneous transhepatic cholangiography, percutaneous biliary drain placement, percutaneous liver biopsy, transarterial liver-directed therapies for malignancy, and liver transplantation. In many of these procedures, the proximity of the biliary ductal system to the hepatic arteries and portal veins predisposes to injury. In other procedures, compromised arterial supply to the biliary system, errors related to complexity of the procedures, or the fragility of the structures themselves may be the root cause. Understanding the etiology of these iatrogenic complications as well as the management options is essential for a multidisciplinary team tasked with managing patients with complex hepatobiliary diseases.

Keywords

biliary interventions - biliary drainage - liver transplant - complications - biloma

Publication History

Received: 13 October 2022

Accepted: 10 January 2023

Article published online:
07 April 2023

• References

• 1 Weber A, Gaa J, Rosca B. et al. Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepatic bile ducts. Eur J Radiol 2009; 72 (03) 412-417
• 2 Venkatanarasimha N, Damodharan K, Gogna A. et al. Diagnosis and management of complications from percutaneous biliary tract interventions. Radiographics 2017; 37 (02) 665-680
• 3 Sutter CM, Ryu RK. Percutaneous management of malignant biliary obstruction. Tech Vasc Interv Radiol 2015; 18 (04) 218-226
• 4 Winick AB, Waybill PN, Venbrux AC. Complications of percutaneous transhepatic biliary interventions. Tech Vasc Interv Radiol 2001; 4 (03) 200-206
• 5 Lee MJ. Biliary intervention. In: Kaufman JA, Lee MJ. eds. Vascular and Interventional Radiology: The Requisites. 2nd ed.. Philadelphia, PA: Mosby; 2014: 451-473
• 6 Al-Bahrani AZ, Holt A, Hamade AM. et al. Acute pancreatitis: an under-recognized risk of percutaneous transhepatic distal biliary intervention. HPB (Oxford) 2006; 8 (06) 446-450
• 7 Saad WEA, Davies MG, Darcy MD. Management of bleeding after percutaneous transhepatic cholangiography or transhepatic biliary drain placement. Tech Vasc Interv Radiol 2008; 11 (01) 60-71
• 8 Lynskey GE, Banovac F, Chang T. Vascular complications associated with percutaneous biliary drainage: a report of three cases. Semin Intervent Radiol 2007; 24 (03) 316-319
• 9 Routh WD, Tatum CM, Lawdahl RB, Rösch J, Keller FS. Tube tamponade: potential pitfall in angiography of arterial hemorrhage associated with percutaneous drainage catheters. Radiology 1990; 174 (3 Pt 2): 945-949
• 10 Kullman E, Frozanpor F, Söderlund C. et al. Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study. Gastrointest Endosc 2010; 72 (05) 915-923
• 11 Lin M-X, Ye JY, Tian WS. et al. Risk factors for bile duct injury after percutaneous thermal ablation of malignant liver tumors: a retrospective case-control study. Dig Dis Sci 2017; 62 (04) 1086-1094
• 12 Takashima H, Moriguchi M, Hayashi N. et al. A simple method to avoid bile duct injury during percutaneous radiofrequency ablation therapy for hepatocellular carcinoma. Case Rep Oncol 2020; 13 (03) 1337-1342
• 13 Dollinger M, Zeman F, Niessen C. et al. Bile duct injury after irreversible electroporation of hepatic malignancies: evaluation of MR imaging findings and laboratory values. J Vasc Interv Radiol 2016; 27 (01) 96-103
• 14 Powerski M, Penzlin S, Hass P. et al. Biliary duct stenosis after image-guided high-dose-rate interstitial brachytherapy of central and hilar liver tumors : a systematic analysis of 102 cases. Strahlenther Onkol 2019; 195 (03) 265-273
• 15 Kobayashi S, Kozaka K, Gabata T. et al. Pathophysiology and imaging findings of bile duct necrosis: a rare but serious complication of transarterial therapy for liver tumors. Cancers (Basel) 2020; 12 (09) 2596
• 16 Atassi B, Bangash AK, Lewandowski RJ. et al. Biliary sequelae following radioembolization with yttrium-90 microspheres. J Vasc Interv Radiol 2008; 19 (05) 691-697
• 17 Hall AD, White SB, Rilling WS. Biliary-caval fistula following Y90 radioembolization. Semin Intervent Radiol 2021; 38 (04) 488-491
• 18 Wu HM, Dixon E, May GR, Sutherland FR. Management of perforation after endoscopic retrograde cholangiopancreatography (ERCP): a population-based review. HPB (Oxford) 2006; 8 (05) 393-399
• 19 Nejjari F, Ouahid S, Adioui T. et al. Unusual complications related to guidewire use during ERCP: an unappreciated injuries. PAMJ Clin Med 2019; 1 (15) 1-4
• 20 Wojcicki M, Milkiewicz P, Silva M. Biliary tract complications after liver transplantation: a review. Dig Surg 2008; 25 (04) 245-257
• 21 Tarantino I, Barresi L, Petridis I, Volpes R, Traina M, Gridelli B. Endoscopic treatment of biliary complications after liver transplantation. World J Gastroenterol 2008; 14 (26) 4185-4189
• 22 Zajko AB, Campbell WL, Logsdon GA. et al. Cholangiographic findings in hepatic artery occlusion after liver transplantation. AJR Am J Roentgenol 1987; 149 (03) 485-489
• 23 Fleischmann D. Multiple detector-row CT angiography of the renal and mesenteric vessels. Eur J Radiol 2003; 45 (Suppl. 01) S79-S87
• 24 Duailibi DF, Ribeiro Jr MAF. Biliary complications following deceased and living donor liver transplantation: a review. Transplant Proc 2010; 42 (02) 517-520
• 25 Calne RY, McMaster P, Portmann B, Wall WJ, Williams R. Observations on preservation, bile drainage and rejection in 64 human orthotopic liver allografts. Ann Surg 1977; 186 (03) 282-290
• 26 Greif F, Bronsther OL, Van Thiel DH. et al. The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation. Ann Surg 1994; 219 (01) 40-45
• 27 Neuhaus P, Blumhardt G, Bechstein WO, Steffen R, Platz KP, Keck H. Technique and results of biliary reconstruction using side-to-side choledochocholedochostomy in 300 orthotopic liver transplants. Ann Surg 1994; 219 (04) 426-434
• 28 Halff G, Todo S, Hall R, Starzl TE. Late complications with gallbladder conduit biliary reconstruction after liver transplantation. Transplantation 1989; 48 (03) 537-539
• 29 Vallera RA, Cotton PB, Clavien PA. Biliary reconstruction for liver transplantation and management of biliary complications: overview and survey of current practices in the United States. Liver Transpl Surg 1995; 1 (03) 143-152
• 30 Renz JF, Emond JC, Yersiz H, Ascher NL, Busuttil RW. Split-liver transplantation in the United States: outcomes of a national survey. Ann Surg 2004; 239 (02) 172-181
• 31 Lake JR. Long-term management of biliary tract complications. Liver Transpl Surg 1995; 1 (5, Suppl 1): 45-54
• 32 Maguire D, Rela M, Heaton ND. Biliary complications after orthotopic liver transplantation. Transplant Rev (Orlando) 2002; 16: 220-240
• 33 Osorio RW, Freise CE, Stock PG. et al. Nonoperative management of biliary leaks after orthotopic liver transplantation. Transplantation 1993; 55 (05) 1074-1077
• 34 Rabkin JM, Orloff SL, Reed MH. et al. Biliary tract complications of side-to-side without T tube versus end-to-end with or without T tube choledochocholedochostomy in liver transplant recipients. Transplantation 1998; 65 (02) 193-199
• 35 Nuño J, Vicente E, Turrión VS. et al. Biliary tract reconstruction after liver transplantation: with or without T-tube?. Transplant Proc 1997; 29 (1-2): 564-565
• 36 Scatton O, Meunier B, Cherqui D. et al. Randomized trial of choledochocholedochostomy with or without a T tube in orthotopic liver transplantation. Ann Surg 2001; 233 (03) 432-437
• 37 Verdonk RC, Buis CI, Porte RJ. et al. Anastomotic biliary strictures after liver transplantation: causes and consequences. Liver Transpl 2006; 12 (05) 726-735
• 38 Jagannath S, Kalloo AN. Biliary complications after liver transplantation. Curr Treat Options Gastroenterol 2002; 5 (02) 101-112
• 39 Testa G, Malagò M, Broelseh CE. Complications of biliary tract in liver transplantation. World J Surg 2001; 25 (10) 1296-1299
• 40 Thuluvath PJ, Atassi T, Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation. Liver Int 2003; 23 (03) 156-162
• 41 Pfau PR, Kochman ML, Lewis JD. et al. Endoscopic management of postoperative biliary complications in orthotopic liver transplantation. Gastrointest Endosc 2000; 52 (01) 55-63
• 42 Saab S, Martin P, Soliman GY. et al. Endoscopic management of biliary leaks after T-tube removal in liver transplant recipients: nasobiliary drainage versus biliary stenting. Liver Transpl 2000; 6 (05) 627-632
• 43 Johnston TD, Gates R, Reddy KS, Nickl NJ, Ranjan D. Nonoperative management of bile leaks following liver transplantation. Clin Transplant 2000; 14 (4 Pt 2): 365-369
• 44 Welling TH, Heidt DG, Englesbe MJ. et al. Biliary complications following liver transplantation in the model for end-stage liver disease era: effect of donor, recipient, and technical factors. Liver Transpl 2008; 14 (01) 73-80
• 45 Tung BY, Kimmey MB. Biliary complications of orthotopic liver transplantation. Dig Dis 1999; 17 (03) 133-144
• 46 Porayko MK, Kondo M, Steers JL. Liver transplantation: late complications of the biliary tract and their management. Semin Liver Dis 1995; 15 (02) 139-155
• 47 Rossi AF, Grosso C, Zanasi G. et al. Long-term efficacy of endoscopic stenting in patients with stricture of the biliary anastomosis after orthotopic liver transplantation. Endoscopy 1998; 30 (04) 360-366
• 48 Mahajani RV, Cotler SJ, Uzer MF. Efficacy of endoscopic management of anastomotic biliary strictures after hepatic transplantation. Endoscopy 2000; 32 (12) 943-949
• 49 Schlitt HJ, Meier PN, Nashan B. et al. Reconstructive surgery for ischemic-type lesions at the bile duct bifurcation after liver transplantation. Ann Surg 1999; 229 (01) 137-145
• 50 Alazmi WM, Fogel EL, Watkins JL. et al. Recurrence rate of anastomotic biliary strictures in patients who have had previous successful endoscopic therapy for anastomotic narrowing after orthotopic liver transplantation. Endoscopy 2006; 38 (06) 571-574
• 51 Hu B, Gao DJ, Wu J, Wang TT, Yang XM, Ye X. Intraductal radiofrequency ablation for refractory benign biliary stricture: pilot feasibility study. Dig Endosc 2014; 26 (04) 581-585
• 52 Zajko AB, Campbell WL, Bron KM, Schade RR, Koneru B, Van Thiel DH. Diagnostic and interventional radiology in liver transplantation. Gastroenterol Clin North Am 1988; 17 (01) 105-143
• 53 Sanchez-Urdazpal L, Gores GJ, Ward EM. et al. Ischemic-type biliary complications after orthotopic liver transplantation. Hepatology 1992; 16 (01) 49-53
• 54 Barton P, Maier A, Steininger R, Mühlbacher F, Lechner G. Biliary sludge after liver transplantation: 1. Imaging findings and efficacy of various imaging procedures. AJR Am J Roentgenol 1995; 164 (04) 859-864
• 55 Gor NV, Levy RM, Ahn J, Kogan D, Dodson SF, Cohen SM. Biliary cast syndrome following liver transplantation: predictive factors and clinical outcomes. Liver Transpl 2008; 14 (10) 1466-1472
• 56 Shah JN, Haigh WG, Lee SP. et al. Biliary casts after orthotopic liver transplantation: clinical factors, treatment, biochemical analysis. Am J Gastroenterol 2003; 98 (08) 1861-1867
• 57 Lemmers A, Pezzullo M, Hadefi A. et al. Biliary cast syndrome after liver transplantation: a cholangiographic evolution study. J Gastroenterol Hepatol 2021; 36 (05) 1366-1377