He CJ, Wang XD, Ge NJ, Liu X, Huang J, Xu W, Ni CF, Yang YF. Coil-assisted N-butyl cyanoacrylate embolization vs covered stent implantation for delayed hemorrhage in hepatobiliary and pancreatic surgery. World J Gastrointest Surg 2025; 17(10): 109260 [PMID: 41178874 DOI: 10.4240/wjgs.v17.i10.109260]
Corresponding Author of This Article
Cai-Fang Ni, MD, Department of Interventional Radiology, The First Affiliated Hospital of Soochow, No. 899 Pinghai Road, Suzhou 215006, Jiangsu Province, China. szncfsuda@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 27, 2025 (publication date) through Nov 15, 2025
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Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Surgery
ISSN
1948-9366
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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He CJ, Wang XD, Ge NJ, Liu X, Huang J, Xu W, Ni CF, Yang YF. Coil-assisted N-butyl cyanoacrylate embolization vs covered stent implantation for delayed hemorrhage in hepatobiliary and pancreatic surgery. World J Gastrointest Surg 2025; 17(10): 109260 [PMID: 41178874 DOI: 10.4240/wjgs.v17.i10.109260]
Cheng-Jian He, Cai-Fang Ni, Department of Interventional Radiology, The First Affiliated Hospital of Soochow, Suzhou 215006, Jiangsu Province, China
Cheng-Jian He, Xiang-Dong Wang, Nai-Jian Ge, Xue Liu, Jian Huang, Wei Xu, Ye-Fa Yang, Mini-invasive Intervention Center, The Third Affiliated Hospital of the Naval Medical University, Shanghai 201800, China
Author contributions: He CJ, Ni CF, and Yang YF conceptualized and designed the study; all authors provided administrative support and study materials and/or patients. He CJ and Ni CF collected and assembled the data, analyzed and interpreted the data, and wrote the manuscript; all authors have read and approved the final manuscript.
Supported by Tengfei Project of Third Affiliated Hospital of the Naval Medical University, No. TF2024TJYQ02.
Institutional review board statement: This retrospective study was approved by the Ethics Committee of the Third Affiliated Hospital of Naval Medical University, Shanghai, China (ethics review number: EHBHKY2024-K-498).
Informed consent statement: Written informed consent was obtained from all participants for using their data in clinical research.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cai-Fang Ni, MD, Department of Interventional Radiology, The First Affiliated Hospital of Soochow, No. 899 Pinghai Road, Suzhou 215006, Jiangsu Province, China. szncfsuda@163.com
Received: May 6, 2025 Revised: June 17, 2025 Accepted: September 8, 2025 Published online: October 27, 2025 Processing time: 171 Days and 17.6 Hours
Abstract
BACKGROUND
Hemorrhage following pancreaticobiliary surgery is a high-risk complication, with a mortality rate of 16%-38%. At present, minimally invasive endovascular intervention comprising superselective arterial embolization (SAE) and covered stent implantation (CSI) is the treatment of choice. However, in certain cases, both SAE and CSI become infeasible.
AIM
To evaluate the effectiveness of coil-assisted N-butyl cyanoacrylate (NBCA) embolization in comparison with that of CSI in managing delayed hemorrhage after hepatobiliary–pancreatic surgery when SAE is infeasible.
METHODS
Ninety-eight continuous patients (n = 105 cases; mean age, 58.4 years) with delayed massive hemorrhage who were treated with coil-assisted NBCA embolization (NBCA group, n = 45) and/or CSI (CSI group, n = 60) were retrospectively evaluated between March 2014 and December 2023. Data on technical and clinical success, 30-day mortality, and severe intervention-related adverse events were collected and analyzed.
RESULTS
The technical and clinical success rates in the NBCA group (100% and 93.3%, respectively) were significantly higher than those in the CSI group (88.3% and 73.3%, respectively), with a statistically significant difference between the two groups (P = 0.019 and 0.010, respectively). The 30-day mortality rates and major intervention-related complications were 17.8% and 0%, respectively, in the NBCA group and 18.3% and 1.7% in the CSI group, respectively, with no statistically significant difference between the two groups.
CONCLUSION
In terms of technical and clinical success, coil-assisted NBCA embolization was more effective than CSI for managing delayed hemorrhage after hepatobiliary–pancreatic surgery when SAE was not feasible.
Core Tip: This relatively large study investigates the safety and efficacy of coil-assisted N-butyl cyanoacrylate (NBCA) embolization and compares it with those of covered stent implantation (CSI) when superselective arterial embolization (SAE) is infeasible. SAE and CSI were performed successfully in only 69% and 68% of patients, respectively. In contrast, we achieved much higher technical and clinical success rates for both the NBCA group (100% and 93.3%, respectively) and the CSI group (88.3% and 73.3%, respectively). In addition, the technical and clinical failure rates of the NBCA group were merely 0% and 6.7%, respectively.
