Cocca S, Carloni L, Marocchi M, Grande G, Bianchini M, Colecchia A, Conigliaro R, Bertani H. Post-trans-arterial chemoembolization hepatic necrosis and biliary stenosis: Clinical charateristics and endoscopic approach. World J Clin Cases 2023; 11(36): 8434-8439 [PMID: 38188216 DOI: 10.12998/wjcc.v11.i36.8434]
Corresponding Author of This Article
Silvia Cocca, MD, PhD, Staff Physician, Gastroenterology and Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Via Pietro Giardini 1355, Modena 41121, Italy. silvia.cocca@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
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/
World J Clin Cases. Dec 26, 2023; 11(36): 8434-8439 Published online Dec 26, 2023. doi: 10.12998/wjcc.v11.i36.8434
Post-trans-arterial chemoembolization hepatic necrosis and biliary stenosis: Clinical charateristics and endoscopic approach
Silvia Cocca, Lorenzo Carloni, Margherita Marocchi, Giuseppe Grande, Marcello Bianchini, Antonio Colecchia, Rita Conigliaro, Helga Bertani
Silvia Cocca, Margherita Marocchi, Giuseppe Grande, Rita Conigliaro, Helga Bertani, Gastroenterology and Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena 41121, Italy
Lorenzo Carloni, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 00100, Italy
Marcello Bianchini, Antonio Colecchia, Department of Internal Medicine, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena 41121, Italy
Author contributions: Cocca S contributed to conceptualization and writing - original draft; Carloni L, Marocchi M, Bertani H, Bianchini M, Colecchia A contributed to contributed to writing - review & editing; Bertani H contributed to supervision; Marocchi M and Grande G contributed to review and figures editing; Conigliaro R contributed to supervision and conceptualization; All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare no conflicts of interest.
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: Silvia Cocca, MD, PhD, Staff Physician, Gastroenterology and Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Via Pietro Giardini 1355, Modena 41121, Italy. silvia.cocca@gmail.com
Received: November 9, 2023 Peer-review started: November 9, 2023 First decision: November 22, 2023 Revised: December 1, 2023 Accepted: December 6, 2023 Article in press: December 6, 2023 Published online: December 26, 2023
Abstract
Liver cancer is the fifth most common tumor and the second highest death-related cancer in the world. Hepatocarcinoma (HCC) represents 90% of liver cancers. According to the Barcelona Clinic Liver Cancer group, different treatment options could be offered to patients in consideration of tumor burden, liver function, patient performance status and biochemical marker serum concentration such as alpha-fetoprotein. Trans-arterial chemoembolization (TACE) is the treatment of choice in patients with diagnosis of unresectable HCC not eligible for liver transplantation, and preserved arterial supply. TACE is known to be safe and its complications are generally mild such as post-TACE syndrome, a self-resolving adverse event that occurs in about 90% of patients after the procedure. However, albeit rarely, more severe adverse events such as biloma, sepsis, hepatic failure, chemoagents induced toxicities, and post-TACE liver necrosis can occur. A prompt diagnosis of these clinical conditions is fundamental to prevent further complications. As a result, biliary stenosis could be a rare post-TACE necrosis complication and can be difficult to manage. Complications from untreated biliary strictures include recurring infections, jaundice, chronic cholestasis, and secondary biliary cirrhosis.
Core Tip: Multifocal hepatocarcinoma (HCC) can benefit from local treatments with curative or down-staging purposes. Trans-arterial chemoembolization (TACE) is the treatment of choice in patients with a diagnosis of HCC not eligible for surgery (resection or liver transplantation) and ablation. TACE is known to be a safe procedure but can lead to both self-limiting mild adverse events and, albeit rarely, severe hepatic and biliary damage due to extensive hepatic ischemia.
