Soumil Singhal, Anurag Mehndiratta, Apoorva Batra, Pallav Bhatter, Vrishit Saraswat, Anubhav Khandelwal, Sanjay Saran Baijal
Gelfoam plug embolization of percutaneous transhepatic biliary drainage tracts is a safe, effective, and straightforward technique to prevent bile leakage and hemorrhage after biliary stenting in malignant obstruction. This method offers an efficient alternative to agent-based embolic techniques such as N-butyl cyanoacrylate glue or metallic coils with minimal morbidity.
PURPOSE: To evaluate the feasibility, safety, and clinical efficacy of percutaneous transhepatic biliary drainage tract embolization using a contrast-labeled Gelfoam plug in patients with malignant biliary obstruction following stenting.
MATERIALS AND METHODS: Between February 2021 and August 2025, 54 patients with malignant biliary obstruction underwent 84 percutaneous transhepatic biliary drainage procedures with tract embolization using a Gelfoam plug. The plug was prepared as a cylindrical roll preloaded into a vascular sheath, with radio-opaque contrast medium (Lipiodol) applied at both ends for fluoroscopic visualization. Fluoroscopy, occasionally supplemented with ultrasound guidance, was used to position the plug so that it extended to the liver capsule. Technical success was defined as complete occlusion of the percutaneous transhepatic biliary drainage tract, assessed by fluoroscopic imaging performed immediately after plug deployment. Clinical success was defined as the absence of bile leakage, hemorrhage, or other complications throughout the hospital stay. Minor and major complications were recorded and classified according to Cardiovascular and Interventional Radiological Society of Europe standards.
RESULTS: Technical success was achieved in all 84 procedures (100%). Clinical success was observed in 87% (47/54) of patients. Two patients experienced minor self-limiting tract bleeding requiring no intervention. Five patients developed pleural effusion or ascites (1 and 4, respectively) requiring drainage and prolonged hospitalization by a mean of 4.5 ± 0.9 days, attributed to plug displacement on follow-up.
CONCLUSION: Gelfoam plug embolization of percutaneous transhepatic biliary drainage tracts is a safe, effective, and straightforward technique to prevent bile leakage and hemorrhage after biliary stenting in malignant obstruction. This method offers an efficient alternative to agent-based embolic techniques such as N-butyl cyanoacrylate glue or metallic coils with minimal morbidity.