Percutaneous embolization of persistent biliary and enteric fistulas with Histoacryl

Abstract

Purpose: To describe our experience with transcatheter n-butyl-2-cyanoacrylate (NBCA) embolization of refractory enteric or biliary fistulas.

Materials and methods: Between March and December 2009, a retrospective analysis of patients with enteric or biliary fistulas revealed 11 cases unresponsive to drainage and treatment with NBCA (seven men; age range, 36-81 y). Fistula output ranged from 100 to 300 mL per day. Embolization was performed 20-55 days (mean, 32 d) after a fistula was noted on a radiograph of the abscess performed through a previously placed percutaneous drainage catheter. Digital subtraction imaging of the abscess via the percutaneous drainage catheter was used to show enteric or biliary communications and fistula tract. After the fistula tract was identified, it was cannulated under fluoroscopic guidance with a guide wire and a 5-F angiographic catheter. In embolization procedures, NBCA was deployed to fill and seal the entire tract and remnant abscess cavity.

Results: In all patients, enteric or biliary fistula output ceased after one or two procedures without any complications. No recurrence was noted during follow-up of 9-17 months.

Conclusions: Persistent enteric or biliary fistulas can be treated successfully by transcatheter image-guided NBCA embolization. This may decrease the morbidity associated with prolonged external drainage and avert the need for surgery.