Combined selective portal vein embolization and excluded bile duct sclerotherapy (SPEEDS) in the treatment of excluded bile ducts

Background: Bile leakage from an excluded bile duct is a rare complication after hepatobiliary surgery. It can cause high-output biliary fistulas with high morbidity or even death. Traditionally, management of this condition has been surgical with liver resection or hepaticojejunostomy. To avoid these high-risk salvage surgeries, minimally invasive procedures have been proposed, but with conflicting results. We hypothesized that a staged combination of both percutaneous transhepatic Selective Portal vein Embolization and Excluded bile Duct Sclerotherapy (SPEEDS) is a feasible, safe, and effective therapy for these patients. Methods: This is a retrospective single-center study from a high-volume hepato-biliary center. We reviewed all consecutive patients with bile leakage from excluded bile ducts from April 2018 until September 2024. Results: We identified nine patients with high-output bile leakage from excluded bile ducts during the study period. All nine patients were managed with the novel SPEEDS technique. The treatment was successful, with complete symptom resolution in all patients and no serious adverse events. Discussion: SPEEDS is a feasible, safe, and effective therapy for patients with bile leakage from excluded bile ducts. Further research and consolidation of the technique are needed.