Percutaneous thoracic duct embolisation for persistent chyle leak
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3 Committee considerations
The evidence
3.1 NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 6 sources, which was discussed by the committee. The evidence included 1 meta-analysis, 1 systematic review and 4 retrospective case series. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.
3.2 The professional experts and the committee considered the key efficacy outcomes to be: reduction in chyle leak, improved quality of life and improved nutrition.
3.3 The professional experts and the committee considered the key safety outcomes to be: pain, bleeding, infection including abdominal sepsis, bile leak and damage to intra-abdominal structures.
3.4 One commentary from a person who has had this procedure was discussed by the committee.
Committee comments
3.5 Most procedures were done through a transabdominal approach, but other approaches could be used.
3.6 The committee was informed that ligating the thoracic duct by thoracotomy was an alternative treatment for this indication.
3.7 The committee was informed that the aetiology of chyle leaks is more complex in children and the procedure may have additional risks in these patients.
Tom Clutton-Brock
Chair, interventional procedures advisory committee
September 2022
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