Transcatheter arterial embolization for iatrogenic bleeding after endoscopic ultrasound-guided pancreaticobiliary drainage

Abstract Purpose 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). Patients and methods 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. Results 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. Conclusion 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.