1 Recommendations

Guidance

1.1 Evidence on the safety and efficacy of percutaneous thoracic duct embolisation for persistent chyle leak is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

1.2 Clinicians wanting to do percutaneous thoracic duct embolisation for persistent chyle leak should:

Inform the clinical governance leads in their healthcare organisation.
Give people (and their families and carers, as appropriate) clear written information to support shared decision making, including NICE's information for the public.
Ensure that people (and their families and carers, as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.

1.3 Healthcare organisations should:

Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.

1.4 Patient selection should be done by a team experienced in managing the condition, including a dietitian.

1.5 The procedure should only be done in specialist centres by clinicians with specific training and experience in this procedure.

1.6 NICE encourages further research into percutaneous thoracic duct embolisation for persistent chyle leak. Research should include details of patient selection, size and position of the leak, approaches used, and short- and long-term efficacy and safety outcomes.