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    Interventional procedure overview of percutaneous thoracic duct embolisation for persistent chyle leak

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    Efficacy summary

    Technical success

    In a meta-analysis of 9 studies including chyle leakage of a variety of aetiologies, the pooled technical success rate of TDE (6 studies) was 63% (95% CI, 55.4% to 70.2%; p=0.157, I2= 37.3%; Kim 2018). In a systematic review of 7 retrospective studies on percutaneous LAG with TDE or TDD for chyle leaks or chylothorax from multiple aetiologies (455 patients, including 180 after oesophageal resection), the median technical success rate for percutaneous TDE was 93% (range 48% to 100%) in 3 studies (Power 2021). In 1 study of chyle leak post oesophagectomy, the technical success rate was 86% (43/50; Pamarthi 2014)

    Clinical success

    In the meta-analysis of 9 studies including chyle leakage of a variety of aetiologies, the pooled clinical success rate of TDE for patients in whom technical success was achieved (6 studies), on a per-protocol basis, was 79% (95% CI, 64.8% to 89.0%; p=0.008, I2= 68.1%). TDD was done in 25% (77/310) of the patients who had TDE because of technical (97%; 75/77) or clinical (3%; 2/77) failure of TDE. Clinical success of TDD was achieved in 61% (47/77) of these patients (Kim 2018). The pooled overall clinical success rate of lymphatic interventions on an ITT basis, based on 6 studies, was 60% (95% CI, 52.1% to 67.7%; p=0.025, I2=54.3%; Kim 2018).

    In the systematic review of 7 retrospective studies, the median clinical success rate (in 4 studies) was 57% (range: 38% to 98%). Four studies reported the outcome of TDE and TDD separately, with a median clinical success rate for TDE of 75% (range 57% to 98%) and a median clinical success rate for TDD of 72% (range 41.7% to 100%, Power 2021). Another study reported clinical success rates of 89% for TDE (n = 9), and 75% for TDD (n= 4) following oesophagectomy. Clinical success of TDE or TDD did not differ based on the type of operation (p=0.67, Yannes 2007).

    In the retrospective case series of 45 patients, the clinical success rate in the TDE group was 89% (31/35), compared with 50% (5/10) in the non-TDE group. Patients in the non-TDE group did not undergo embolisation because of lack of targetable central lymphatics in LAG (n = 5), technical failures of TDC (n = 3), and lack of discernible leakage in trans-TDC catheter lymphangiography (n = 2). The overall clinical success on an ITT basis was 80% (36/45, Jun 2022).

    In a retrospective case series of 52 patients with non-traumatic chylothorax, resolution of chylothorax was reported in 93% (38/41) of patients who had TDE and lymphatic embolisation for abnormal pulmonary lymphatic flow (Gurevich 2022).