Transjugular intrahepatic portosystemic shunt creation for portal hypertension in patients with hepatocellular carcinoma: A systematic review

He Zhao,Jiaywei Tsauo,Tao Gong,Jinggui Li,Xiao Li 소화기인터벤션의학회 2018 Gastrointestinal Intervention Vol.7 No.3

Background: To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) creation for the management of portal hypertension in patients with hepatocellular carcinoma (HCC). Methods: A literature search of the MEDLINE/PubMed and Embase databases was conducted. All articles reporting the outcomes of TIPS creation for variceal bleeding and refractory ascites and hepatic hydrothorax in patients with HCC were included. Exclusion criteria were non-English language, sample size < 5, data not extractable, and data reported in another article. Results: A total of 280 patients (mean age, 48–58; male gender, 66%) from five articles were included. TIPS creation was performed for variceal bleeding in 79% and refractory ascites and/or hepatic hydrothorax in 26% of patients. Technical and clinical success was achieved in 99% and 64% of patients, respectively. Clinical failure occurred in 36% of patients due to rebleeding or recurrent bleeding (n = 77) or no resolution or improvement of refractory ascites and hepatic hydrothorax (n = 24). One percent of patient had major complications, including accelerated liver failure (n = 1) and multi-organ failure resulting from hemorrhagic shock (n = 1), all of which resulted in early (i.e., within 30 days) death. Hepatic encephalopathy occurred in 40% of patients after TIPS creation. Lung metastasis was found 1% of patient 5 months (n = 1) and 72 months (n = 1) after TIPS creation. Conclusion: TIPS creation seems to be safe and effective for the management of portal hypertension in patients with HCC.

Techniques for percutaneous transesophageal gastrotubing

Yozo Sato,Shohei Chatani,Takaaki Hasegawa,Shinichi Murata,Yoshitaka Inaba 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.2

Percutaneous transesophageal gastrotubing (PTEG) procedure was developed in Japan as an alternative access route into the gastrointestinal tract, and it has been performed for patients in whom percutaneous endoscopic gastrostomy would be technically difficult to place or is contraindicated, such as in a prior gastrectomy and massive ascites. In the PTEG procedure, an indwelling tube is inserted through the cervical esophagus, which gives the patient a slight discomfort after the tube placement. Therefore, PTEG is performed not only for enteral feeding, but also for bowel decompression as a palliative care in patients with malignant gastrointestinal obstruction. Recently, several reports of PTEG from countries outside Japan indicated a high technical success rate without major complications. Furthermore, the usefulness of PTEG for bowel decompression as a palliative care was reported in prospective studies. In fact, PTEG is a technically feasible and safe procedure worldwide.

Recent update of percutaneous radiologic jejunostomy

Charles Y. Kim,Ji Hoon Shin 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.2

Although percutaneous radiologic jejunostomy has not been widely accepted as a primary insertion technique due to the technical difficulty for inexperienced operators, it may be a crucial procedure for patients with previous gastrectomy or an otherwise inaccessible stomach, particularly in patients who are not candidates for a surgical jejunostomy. Targeting the appropriate target jejunal loop and affixing the bowel with a t-fastener anchor are the most important and challenging technical steps. Technical success rate ranged from 92% to 100% based on 19 to 106 patients in several representative reports, with major complications ranging from 3.9% to 13.0%.

Fluoroscopy-guided gastrojejunostomy: A work in progress

Jingui Li,Tao Gong,Jiaywei Tsauo 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.2

Surgical gastrojejunostomy (GJ) has traditionally been the mainstay of treatment for malignant gastric outlet obstruction (GOO). However, most patients preferentially choose to undergo self-expandable metal stent (SEMS) placement due to its minimally invasive nature, although it is wellrecognized that surgical GJ is associated with longer patency and less reinterventions than SEMS placement. Endoscopic ultrasound (EUS)-guided GJ has recently emerged as a novel procedure for the treatment of malignant GOO. This procedure offers a non-surgical means of performing GJ, but its widespread use is limited because it could only be performed by experienced endoscopists with expertise in EUS-guided procedures. The authors performed fluoroscopy-guided GJ in eight domestic pigs by puncturing the proximal jejunum from the stomach using a Rösch-Uchida transjugular liver access set followed by the placement of a lumen-apposing metal stent across the puncture tract. The results showed that fluoroscopy-guided GJ may be a technically feasible and simple procedure but, before clinical trials can be undertaken, further technical refinements are required to reduce the risk of inadvertent transgression of non-target organs.

Radiological gastrostomy: A comparative analysis of different image-guided methods

Hong-Tao Hu,Hang Yuan,Chen-Yang Guo,Quan-Jun Yao,Xiang Geng,Hong-Tao Cheng,Jun-Li Ma,Yan Zhao,Li Jiang,Yu-Qing Zhao,Hai-Liang Li 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.2

Background: Radiographic guided percutaneous gastrostomy has become a safe and effective enteral nutrition method for patients who can not eat by mouth. Fluoroscopy, computed tomography (CT) and cone-beam CT have been routinely used clinically. The aim of this study was to compare the advantages and disadvantages of percutaneous gastrostomy using different radiographic guided methods. Methods: We retrospectively analyzed the clinical data of 538 patients undergoing percutaneous gastrostomy in our department. According to the image guidance method used in gastrostomy, the patients were divided into groups A by fluoroscopy guidance, group B by fluoroscopy combined with C-arm CT guidance, and group C with the whole process CT guidance. The gastrostomy success rate, complication rate, procedure time, and patient radiation dose were analyzed in the three groups. Results: Among 538 patients, 534 were successful and the success rates are 94.3%, 99.3%, and 100% in group A, B, and C, respectively (P > 0.05). There were 3 cases occurred postoperative bleeding as serious adverse events and transferred to surgical gastrostomy. The minor complications include local infection, hyperplasia of granulation tissue, tube obstruction or prolapse, and local pain of the ostomy. The minor complication rates were 10.5%, 10.4%, and 7.7% in group A, B, and C, respectively (P > 0.05). The average procedure time was 25.57 ± 5.99 minutes, 29.01 ± 6.63 minutes, and 45.47 ± 8.98 minutes, respectively (χ2 = 87.98, P < 0.001). The average radiation dosage was 27.30 ± 19.27 mGy, 145.07 ± 106.08 mGy, and 2,590.26 ± 1,088.22 mGy, respectively (χ2 = 204.44, P < 0.001). Conclusion: There were no significant differences in the success rates and complication rates of gastrostomy under the three guiding methods. For difficult cases, CT-guided gastrostomy may be a very useful supplemental method.

Percutaneous radiologic gastrostomy in patients with amyotrophic lateral sclerosis: A safe and effective technique

Chen Xu,Zheng-Qiang Yang,Sheng Liu,Wei Yang,Hai-Bin Shi,Wei-Zhong Zhou 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.2

Background: Percutaneous radiologic gastrostomy (PRG) was considered as an alternative technique for long-term enteral nutrition, and the current study is aimed to evaluate the feasibility and safety of this technique in patients with amyotrophic lateral sclerosis (ALS) at a single medical center. Methods: From July 2017 to October 2020, a total of 14 patients underwent PRG with ALS were included in this retrospective study with a median age of 64.0 years, and 78.6% were male. The procedure comprised a dilation of the stomach via a nasogastric catheter, followed by puncture and gastrostomy tube placement under fluoroscopic guidance. The technical success rate and clinical outcomes were recorded over 3 months following the procedure. Results: The technical success rate was 100%. During the follow-up period, minor complications were reported in 2 of patients (14.3%) including superficial skin infection and early tube block. Neither major complications nor mortality were observed. Body mass index of the patients increased significantly from 16.4 ± 2.1 kg/m2 to 17.1 ± 2.0 kg/m2 (t = –13.77; P < 0.001), and the albumin level increased significantly from 37.5 ± 2.3 g/L to 41.8 ± 1.6 g/L (t = –8.82, P < 0.001). Conclusion: PRG is a relatively safe and effective method for ALS patients, and deserves widespread clinical acceptance.

Percutaneous transsplenic obliteration of ectopic varices following pancreaticoduodenectomy with portal vein resection and splenic vein ligation

Shohei Chatani,Yozo Sato,Nozomi Okuno,Takaaki Hasegawa,Shinichi Murata,Hidekazu Yamaura,Kazuo Hara,Yasuhiro Shimizu,Yoshitaka Inaba 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.2

Left-sided portal hypertension following pancreaticoduodenectomy (PD) with portal vein resection and splenic vein ligation may cause ectopic variceal formation, potentially resulting in life-threatening bleeding. We report of a 79-year-old male suffering from severe anemia and melena after PD. Emergency endoscopy and contrast-enhanced computed tomography (CECT) revealed ectopic varices at the anastomosis site of pancreaticojejunostomy. An interventional radiology approach was preferred over surgical and endoscopic treatment because of the poor general condition and altered anatomy. In the first procedure, percutaneous transhepatic retrograde obliteration was performed using the coaxial double balloon-occlusion technique. Although hemostasis was obtained, re-bleeding occurred two months later. CECT revealed the development of another collateral pathway and the recurrence of varices. Insufficient embolization of the afferent vein was considered the cause of recurrence. Therefore, a percutaneous transsplenic approach was used, and complete embolization of varices was achieved. When transhepatic retrograde obliteration is not effective, transsplenic antegrade obliteration can be a useful therapeutic option.

Ampulla of Vater metastasis from squamous cell carcinoma of the esophagus

Jun Hyuk Son,Jung Su Lee,Jong Wook Kim,Nam-Hoon Kim,Han-Seong Kim,Yoon Suk Lee 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.2

Esophageal cancer is one of the lethal malignant tumors because it is often diagnosed in the advanced stage with lymph node or distant metastasis. The recurrence rate of esophageal cancer is known to be about 40% to 50% even in the patients who underwent curative esophageal resection. Most frequent sites of metastases are known to be the liver. Furthermore, other distant metastases also could be developed in lung, bone, brain, kidney, adrenal, abdominal cavity, and skin. However, ampulla of Vater (AoV) metastasis rarely occurs from esophageal cancer. Therefore, we report herein a case of AoV metastasis from squamous cell carcinoma of the esophagus.

Foreign bodies in common bile duct in post cholecystectomy status—case series of 8 cases—A single center experience in western India

Pankaj N. Desai,Chintan N. Patel,Mayank V. Kabrawala,Subhash K. Nandwani,Rajiv M. Mehta,Parika Kalra,Ritesh Prajapati,Nisharg Patel,Krishna K. Parekh 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.2

Foreign bodies in common bile duct (CBD) are rare. Obstructive jaundice in patients who have undergone cholecystectomy may be due to a variety of causes. Common causes of obstruction in these cases are residual stones, inflammatory or ischaemic strictures following CBD injury during cholecystectomy or malignant strictures. Foreign bodies in the bile duct in these post cholecystectomy patients are known but reported very rarely. Clinical features and biochemistry of these patients are no different than those due to other causes mentioned above. Imaging studies will show obstruction due to stones or sludge or narrowing but may not give conclusive diagnosis of a foreign body. Endoscopic ultrasound is helpful in these cases as it shows a hyperechoic foreign body within the stone if the substance is a metallic clip. In our current case series, we are presenting eight such cases with post cholecystectomy foreign bodies, in the form of materials used for ligating or clipping the cystic duct before transection during cholecystectomy, or a mistakenly left behind gauze piece, migrating into the bile duct and forming a nidus for stone formation and causing CBD obstruction. To conclude, if a patient presents with biliary obstruction with a history of cholecystectomy, the possibility of foreign body in the CBD must be considered as a possible differential diagnosis.

Usefulness of endoscopic pancreatography without contrast agents and efficacy of transpapillary intervention for pancreatic duct rupture in chronic pancreatitis: Our study of 321 cases in 11 years

Pankaj N. Desai,Chintan N. Patel,Mayank V. Kabrawala,Subhash K. Nandwani,Rajiv M. Mehta,Ritesh M. Prajapati,Nisharg B. Patel,Krishna K. Parekh,Neha D. Sheth 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.1

Background: To assess the usefulness of endoscopic pancreatography without contrast agents and efficacy of transpapillary intervention for pancreatic duct (PD) rupture in chronic pancreatitis. Methods: We retrospectively analyzed all cases of chronic pancreatitis with ductal rupture causing ascites, effusions and pseudocysts. We performed magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde pancreatography (ERP) without contrast. Results observed based on the possibility of wire crossing the leak or not and their resolutions were noted. Results: We performed ERP in 1,324 patients. Ductal disruptions in 321/1,324 (24.2%). We divided cases into two groups. Group 1 involves disruptions causing ascites in 60 cases (18.7%) and effusions in 34 cases (10.6%), and group 2 involves pseudocysts in 227 cases (70.7%). In group 1, 82 patients (87.2%) experienced successful cannulation of PD. Leak crossed in 70 (74.5%) with complete resolution in all. Leak did not cross in 12 cases of which 8 (8.5%) installed stents resolved while four (4.3%) did not resolve. In group 2, 219 (96.5%) PD cannulated. Leak did not cross but stents put in cyst (176, 77.5%). Complete resolution occurred without infection. Leaks were crossed in 43 (18.9%); complete resolution, 14 (32.6%). Complete regression was not achieved in 19 (8.3%). Eight cysts were not resolved (3.5%). Transmural drainage was done. Infection was noted in 2 cases (0.9%). Sites of leak in pseudocysts were jenu & body, 167 (73.6%); tail, 60 (26.4%). We recorded pancreas divisum in 24/321 (7.5%). ERP failed in 20 (6.2%). Three were managed medically (1.3%), 5 with distal pancreatectomy (2.2%), 4 with lateral pancreatico jejunostomy (1.8%), and 8 with transmural drainage (3.5%). Conclusion: PD rupture in chronic pancreatitis can be managed transpapillary, without any contrast during ERP. In majority, endosonography aspiration and transmural drainage are needed only when transpapillary fails. Leak from tail responded better than those from proximal duct with ERP.