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Wang GC, Huang GJ, Zhang CQ, Ding Q. Percutaneous transhepatic intraportal biopsy using gastroscope biopsy forceps for diagnosis of a pancreatic neuroendocrine neoplasm: A case report. World J Gastroenterol 2023; 29:1235-1242. [PMID: 36926671 PMCID: PMC10011950 DOI: 10.3748/wjg.v29.i7.1235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/19/2023] [Accepted: 02/01/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Pancreatic neuroendocrine neoplasms (PNENs) are a rare group of neoplasms originating from the islets of the Langerhans. Portal vein tumor thrombosis has been reported in 33% of patients with PNENs. While the histopathological diagnosis of PNENs is usually based on percutaneous biopsy or endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), these approaches may be impeded by gastric varices, poor access windows, or anatomically contiguous critical structures. Obtaining a pathological diagnosis using a gastroscope biopsy forceps via percutaneous transhepatic intravascular pathway is an innovative method that has rarely been reported.
CASE SUMMARY A 72-year-old man was referred to our hospital for abdominal pain and melena. Abdominal contrast-enhanced magnetic resonance imaging revealed a well-enhanced tumor (size: 2.4 cm × 1.2 cm × 1.2 cm) in the pancreatic tail with portal vein invasion. Traditional pathological diagnosis via EUS-FNA was not possible because of diffuse gastric varices. We performed a percutaneous transportal biopsy of the portal vein tumor thrombus using a gastroscope biopsy forceps. Histopathologic examination revealed a pancreatic neuroendocrine neoplasm (G2) with somatostatin receptors 2 (+), allowing systemic treatment.
CONCLUSION Intravascular biopsy using gastroscope biopsy forceps appears to be a safe and effective method for obtaining a histopathological diagnosis. Although well-designed clinic trials are required to obtain more definitive evidence, this procedure may help improve the diagnosis of portal vein thrombosis and related diseases.
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Affiliation(s)
- Guang-Chuan Wang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Guang-Jun Huang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Chun-Qing Zhang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Qian Ding
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
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Mekaroonkamol P, Cohen R, Chawla S. Portal hypertensive enteropathy. World J Hepatol 2015; 7:127-138. [PMID: 25729469 PMCID: PMC4342596 DOI: 10.4254/wjh.v7.i2.127] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/28/2014] [Accepted: 11/17/2014] [Indexed: 02/06/2023] Open
Abstract
Portal hypertensive enteropathy (PHE) is a condition that describes the pathologic changes and mucosal abnormalities observed in the small intestine of patients with portal hypertension. This entity is being increasingly recognized and better understood over the past decade due to increased accessibility of the small intestine made possible by the introduction of video capsule endoscopy and deep enteroscopy. Though challenged by its diverse endoscopic appearance, multiple scoring systems have been proposed to classify the endoscopic presentation and grade its severity. Endoscopic findings can be broadly categorized into vascular and non-vascular lesions with many subtypes of both categories. Clinical manifestations of PHE can range from asymptomatic incidental findings to fatal gastrointestinal hemorrhage. Classic endoscopic findings in the setting of portal hypertension may lead to a prompt diagnosis. Occasionally histopathology and cross sectional imaging like computed tomography or magnetic resonance imaging may be helpful in establishing a diagnosis. Management of overt bleeding requires multidisciplinary approach involving hepatologists, endoscopists, surgeons, and interventional radiologists. Adequate resuscitation, reduction of portal pressure, and endoscopic therapeutic intervention remain the main principles of the initial treatment. This article reviews the existing evidence on PHE with emphasis on its classification, diagnosis, clinical manifestations, endoscopic appearance, pathological findings, and clinical management. A new schematic management of ectopic variceal bleed is also proposed.
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Affiliation(s)
- Parit Mekaroonkamol
- Parit Mekaroonkamol, Robert Cohen, Saurabh Chawla, Grady Memorial Hospital, Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Robert Cohen
- Parit Mekaroonkamol, Robert Cohen, Saurabh Chawla, Grady Memorial Hospital, Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Saurabh Chawla
- Parit Mekaroonkamol, Robert Cohen, Saurabh Chawla, Grady Memorial Hospital, Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
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Kawai N, Minamiguchi H, Sato M, Ikoma A, Sanda H, Nakata K, Tanaka T, Nakai M, Sonomura T. Percutaneous transportal outflow-vessel-occluded sclerotherapy for gastric varices unmanageable by balloon-occluded retrograde transvenous obliteration. Hepatol Res 2013; 43:430-5. [PMID: 23560864 DOI: 10.1111/j.1872-034x.2012.01078.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In this report we introduce percutaneous transportal outflow-vessel-occluded sclerotherapy (PTOS) for gastric varices unmanageable by balloon-occluded retrograde transvenous obliteration (BRTO) in two cases and evaluate its safety and efficacy. The PTOS is a technique which could obstruct gastric varices subsequent to the occlusion of the outflow route, being based on the rationale of BRTO. In the PTOS procedure, coil embolization of the outflow vessel is first conducted through a microcatheter advanced beyond the gastric varices via the percutaneous transhepatic approach; sclerosing agent (5% ethanolamine oleate) is then injected into the gastric varices after confirmation of static blood flow in the varices. Two patients underwent initial BRTO that eventually failed because of the presence of numerous fine and abruptly angled outflow vessels (case 1), and the presence of a tortuous and elongated outflow vessel accompanied by numerous small collateral outflows that could not be occluded (case 2). Cases 1 and 2 received PTOS using 5% ethanolamine oleate (15 mL and 10 mL, respectively). Portal venous pressure following PTOS showed an increase from 29 to 34 mmHg in case 1 and remained at 24 mmHg in case 2. No major complication was encountered in either patient. One-year follow-up gastroendoscopy showed no recurrence of gastric varices in either patient. Although PTOS is slightly more invasive than BRTO, PTOS can be used as an alternative catheter treatment procedure for gastric varices that are unmanageable by BRTO.
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Affiliation(s)
- Nobuyuki Kawai
- Department of Radiology, Wakayama Medical University, Radiology, Wakayama, Japan
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Abstract
Ectopic varices (EcV) comprise large portosystemic venous collaterals located anywhere other than the gastro-oesophageal region. No large series or randomized-controlled trials address this subject, and therefore its management is based on available expertise and facilities, and may require a multidisciplinary team approach. EcV are common findings during endoscopy in portal hypertensive patients and their bleeding accounts for only 1–5% of all variceal bleeding. EcV develop secondary to portal hypertension (PHT), surgical procedures, anomalies in venous outflow, or abdominal vascular thrombosis and may be familial in origin. Bleeding EcV may present with anaemia, shock, haematemesis, melaena or haematochezia and should be considered in patients with PHT and gastrointestinal bleeding or anaemia of obscure origin. EcV may be discovered during panendoscopy, enteroscopy, endoscopic ultrasound, wireless capsule endoscopy, diagnostic angiography, multislice helical computed tomography, magnetic resonance angiography, colour Doppler-flow imaging, laparotomy, laparoscopy and occasionally during autopsy. Patients with suspected EcV bleeding need immediate assessment, resuscitation, haemodynamic stabilization and referral to specialist centres. Management of EcV involves medical, endoscopic, interventional radiological and surgical modalities depending on patients’ condition, site of varices, available expertise and patients’ subsequent management plan.
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TORIYA H, MAESHIRO K, YOSHIMURA S, SHIRAI Z, ARIMA S, SHIMURA H, OYAMA Y, NAKAOKA K, KOKAWA H, TOKUMITSU H, SAKAGUCHI S, OKUMURA M, OKAZAKI M. Combined Non‐Surgical Treatment with Transileocolic Obliteration and Endoscopic Injection Sclerotherapy for Esophageal and Gastric Varices. Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.1989.tb00033.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Hiroshi TORIYA
- *The First Department of Surgery, School of Medicine, Fukuoka University, Japan
| | - Kensei MAESHIRO
- *The First Department of Surgery, School of Medicine, Fukuoka University, Japan
| | - Sigeaki YOSHIMURA
- *The First Department of Surgery, School of Medicine, Fukuoka University, Japan
| | - Zentaro SHIRAI
- *The First Department of Surgery, School of Medicine, Fukuoka University, Japan
| | - Sumitaka ARIMA
- *The First Department of Surgery, School of Medicine, Fukuoka University, Japan
| | - Hidehiko SHIMURA
- *The First Department of Surgery, School of Medicine, Fukuoka University, Japan
| | - Youichi OYAMA
- **The First Department of Internal Medicine, School of Medicine, Fukuoka University, Japan
| | - Kouichi NAKAOKA
- **The First Department of Internal Medicine, School of Medicine, Fukuoka University, Japan
| | - Hiroshi KOKAWA
- **The First Department of Internal Medicine, School of Medicine, Fukuoka University, Japan
| | - Hideo TOKUMITSU
- **The First Department of Internal Medicine, School of Medicine, Fukuoka University, Japan
| | - Seigo SAKAGUCHI
- **The First Department of Internal Medicine, School of Medicine, Fukuoka University, Japan
| | - Makoto OKUMURA
- **The First Department of Internal Medicine, School of Medicine, Fukuoka University, Japan
| | - Masatoshi OKAZAKI
- ***The Department of Radiology, School of Medicine, Fukuoka University, Japan
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Sharafuddin MJ, Gu X, Urness M, Amplatz K. The nitinol vascular occlusion plug: preliminary experimental evaluation in peripheral veins. J Vasc Interv Radiol 1999; 10:23-7. [PMID: 10872485 DOI: 10.1016/s1051-0443(99)70004-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To compare the nitinol occlusion plug with standard stainless steel coils for the occlusion of moderate-size peripheral veins. MATERIALS AND METHODS The nitinol plug is a braided multilayered vascular occlusion device filled with thrombogenic polyester fibers. It is self-expanding and can be recaptured into its 6-F introducing sheath for repositioning prior to detachment. Ten occlusion procedures were performed in five dogs from a retrograde transjugular venous approach. Five nitinol plugs (diameter: 7.4 mm +/- 0.5) were deployed in five femoropopliteal veins (diameter: 6.5 mm +/- 0.7; mean oversizing 14.6%). Two sequential Gianturco coils (diameter: 7.4 mm +/- 0.9) were deployed in the corresponding contralateral veins (diameter: 6.2 mm +/- 0.8; mean oversizing 19.6%). Follow-up venography was performed at 1 month, following which the animals were killed and the vessels were explanted. RESULTS Time-to-occlusion was significantly shorter with the nitinol plug as compared to two Gianturco coils (4.2 minutes +/- 3.4 vs 25.6 minutes +/- 14.1, respectively [P < .03]). At 1 month all but one coil-doublet (80%) had recanalized or migrated, compared to only one nitinol occluder (20%, P < .04). Histopathologic examination of plug-occluded veins showed a uniform organized matrix and underlying intimal proliferative response. CONCLUSION A single nitinol occluder resulted in significantly faster occlusion time and significantly lower recanalization or migration rate than two Gianturco coils, in moderate-size peripheral veins.
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Affiliation(s)
- M J Sharafuddin
- Department of Radiology, University of Iowa Hospitals & Clinics, Iowa City, USA
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Affiliation(s)
- I D Norton
- Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, MN 55905, USA
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Evanson EJ, McIvor J, Murray-Lyon IM, Reynolds KW. Survival after transhepatic embolization of gastro-oesophageal varices. Clin Radiol 1991; 44:178-80. [PMID: 1914394 DOI: 10.1016/s0009-9260(05)80864-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Twenty-five transhepatic embolization procedures were carried out between 1984 and 1989 on 24 patients with life-threatening haemorrhage from gastric or oesophageal varices after conservative methods had failed. There were two deaths related to the procedure and another 17 patients died during the following year. There were five survivors at 1 year, four are alive and well 4 years later, the fifth was lost to follow-up at 2 1/2 years. Survival at 1 year was not affected by a number of factors present at the time of embolization including the underlying liver pathology, the patient's age, platelet count, blood urea, serum bilirubin or the embolization technique. However, survival at 1 year was related to more normal coagulation values (international normalized ratios, INR) P less than 0.005, normal serum aspartate aminotransferase levels (P less than 0.025) and Pugh's grade A (P less than 0.01). We conclude that this procedure can prolong the survival of a small proportion of good risk patients.
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Affiliation(s)
- E J Evanson
- Department of Radiology, Charing Cross Hospital, London
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Hasan M, Rahman MT, Khan AK. Endoscopic sclerotherapy in the treatment of esophageal varices--Bangladesh experience. GASTROENTEROLOGIA JAPONICA 1991; 26 Suppl 3:18-21. [PMID: 1884947 DOI: 10.1007/bf02779255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- M Hasan
- Institute of Postgraduate Medicine & Research, Dhaka, Bangladesh
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Abstract
Rational treatment of portal hypertensive complications requires a knowledge of the cause of portal hypertension and an assessment of the severity of liver disease. In the United States, chronic liver disease, usually due to alcohol, is the most common underlying cause. The history, physical examination, and laboratory analysis are usually sufficient to confirm the presence of underlying liver disease. If there is any question as to the etiology of portal hypertension, however, a more complete evaluation is required, whether the presenting complication is ascites, variceal bleeding, or hypersplenism. Usually, such an evaluation will require a liver biopsy, portal pressure measurement, and angiography. Occasionally, a noninvasive evaluation will be sufficient, but the value of these noninvasive parameters is still under investigation. Surgical mortality generally depends on the severity of the liver disease. Therefore, surgical intervention must be carefully considered in comparison to other therapeutic modalities depending on the patient's hepatic functional reserve. Secondary bacterial peritonitis due to perforation requires surgery regardless of the severity of the underlying liver disease.
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Affiliation(s)
- J C Hoefs
- Department of Medicine, University of California, Irvine Medical Center, Orange
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11
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Menu Y, Gayet B, Nahum H. Bleeding duodenal varices: diagnosis and treatment by percutaneous portography and transcatheter embolization. GASTROINTESTINAL RADIOLOGY 1987; 12:111-3. [PMID: 3493935 DOI: 10.1007/bf01885117] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The authors present a case of massive bleeding from duodenal varices documented by selective portography and successfully controlled by percutaneous embolization.
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Weissmann HS, Byun KJ, Freeman LM. Role of Tc-99m IDA scintigraphy in the evaluation of hepatobiliary trauma. Semin Nucl Med 1983; 13:199-222. [PMID: 6353585 DOI: 10.1016/s0001-2998(83)80016-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Each year approximately 52 million Americans are injured, of which 11 million require hospitalization and 110,000 die. This has an associated health care cost of 3 billion dollars. Hepatobiliary injuries have always constituted a significant area of involvement. They have become more easily detectable since the advent of technetium-99m analogs of iminodiacetic acid (IDA). Biliary leakage secondary to other causes, such as inflammation, neoplasm, and iatrogenic factors are also well demonstrated in a safe, simple, and rapid manner with radionuclide imaging. The relatively low patient radiation dose that is associated with these procedures permits follow-up studies when necessary.
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Garden OJ, Osborne DH, Blamey SL, Carter DC. The management of acute variceal haemorrhage. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1983; 53:197-202. [PMID: 6603836 DOI: 10.1111/j.1445-2197.1983.tb02428.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Sixty-two patients presented on 81 occasions with acute-oesophageal variceal haemorrhage. Bleeding required tamponade on or during that admission on 87 occasions and was successful in arresting haemorrhage in 93%. Employing a policy of management in which injection sclerotherapy was the main therapeutic option, control of haemorrhage was achieved on 89% of admissions with an admission mortality of 30%. These results are compared with other reported series.
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Kadir S, Ernst CB. Current concepts in angiographic management of gastrointestinal bleeding. Curr Probl Surg 1983; 20:281-343. [PMID: 6601567 DOI: 10.1016/s0011-3840(83)80011-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Burroughs AK, Bass NM, Osborne D, Dick R, Hobbs KF, Sherlock S. Randomised, controlled study of transhepatic obliteration of varices and oesophageal stapling transection in uncontrolled variceal haemorrhage. LIVER 1983; 3:122-8. [PMID: 6603567 DOI: 10.1111/j.1600-0676.1983.tb00858.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Percutaneous transhepatic obliteration and surgical stapling transection of the oesophagus with the EEA gun were compared prospectively in the treatment of uncontrolled oesophageal variceal haemorrhage unresponsive to conservative measures. Twenty patients with cirrhosis, with a patient portal vein and who were considered suitable for general anaesthesia and surgery, were randomised to two treatment groups (10 patients each). Immediate arrest of haemorrhage was achieved in 17 patients (nine surgery, eight obliteration). In one other patient, stapling transection succeeded where attempted transhepatic obliteration failed, and in another patient obliteration succeeded where attempted transection had failed. One patient continued to bleed and died following attempts at both procedures. Two other patients also died in hospital, without rebleeding following surgery. Variceal rebleeding during the same hospital admission occurred in two patients in the obliteration group and in none after surgery. Oesophageal stapling transection compares very favourably with a non-surgical technique such as transhepatic obliteration of varices in the emergency treatment of uncontrolled variceal haemorrhage in patients with moderate liver failure.
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Jones B, Douglas M, Smallwood R. Strategies in the management of bleeding varices. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1982; 12:320-324. [PMID: 6753819 DOI: 10.1111/j.1445-5994.1982.tb03820.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Abstract
Gastrointestinal bleeding is a major reason for hospitalization and an important cause of morbidity and mortality. Diagnosis and treatment of this common clinical problem has changed markedly over the past 40 years. The initial approach to patients with gastrointestinal bleeding should be both therapeutic and diagnostic, with close attention to cardiovascular status and clotting parameters. Once the patient is stabilized, clinical history, physical examination, gastric aspirate, and laboratory data should be assessed to determine if the bleeding site is in the upper or lower gastrointestinal tract. Once that is determined, a more specific diagnosis should be made if possible, as therapy often will depend upon a precise diagnosis. Therapy includes angiographic and pharmacologic techniques, as well as tamponade in the case of esophageal varices. The use of antacids in acute upper gastrointestinal bleeding is well established, while the role of cimetidine is less clear. Newer modalities of treatment, such as the use of laser coagulation, are currently being evaluated.
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Chapman AH. Report on the Kodak Travelling Scholarship Section I: Interventional Radiology. Section II: Undergraduate Radiology Training in North America. Clin Radiol 1982; 33:241-51. [PMID: 6210483 DOI: 10.1016/s0009-9260(82)80251-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Johnson WC, Nabseth DC, Widrich WC, Bush HL, O'Hara ET, Robbins AH. Bleeding esophageal varices: treatment with vasopressin, transhepatic embolization and selective splenorenal shunting. Ann Surg 1982; 195:393-400. [PMID: 6978109 PMCID: PMC1352518 DOI: 10.1097/00000658-198204000-00003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The fate of 359 consecutive alcoholic cirrhotic male patients with bleeding esophageal varices was determined through chart review and personal interview. Three historical periods (1966-70; 1971-75; 1976-80) were defined based on availability of different therapeutic modalities. Management of acutely bleeding varices by conservative, nonsurgical means, including embolization, was preferable to emergency surgery when considering 30-day mortality rates. Percutaneous transhepatic embolization of esophagogastric varices significantly improved the rate of control of hemorrhage and 30-day survival over previously employed nonsurgical methods. The combination of nonsurgical management of acute variceal hemorrhage followed by selective distal splenorenal shunting resulted in maximum salvage of the alcoholic cirrhotic patient.
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Abstract
Control of acute variceal bleeding by transhepatic embolization was investigated in 14 patients with alcoholic liver disease. In these patients hemorrhage was unresponsive to general supportive measures, intravenous vasopressin and balloon tamponade. Embolization was performed using Gelfoam and a synthetic polymer, bucrylate. Acute hemorrhage was arrested in 86 percent of patients. Rebleeding after transhepatic embolization occurred in 35 percent of patients. There were three deaths from intraabdominal hemorrhage related directly to transhepatic embolization (21 percent). Six patients (43 percent) left the hospital alive. In a group of cirrhotic patients in whom transhepatic embolization was employed after traditional modes of therapy had failed to control variceal hemorrhage, mortality and rebleeding rates were high.
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Terblanche J, Yakoob HI, Bornman PC, Stiegmann GV, Bane R, Jonker M, Wright J, Kirsch R. Acute bleeding varices: a five-year prospective evaluation of tamponade and sclerotherapy. Ann Surg 1981; 194:521-30. [PMID: 7025770 PMCID: PMC1345335 DOI: 10.1097/00000658-198110000-00015] [Citation(s) in RCA: 125] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In a five-year study of massive upper gastrointestinal hemorrhage, 143 patients had esophageal varices diagnosed on emergency endoscopic examination. Seventy-one patients had active bleeding from varices and required Sengstaken tube tamponade during at least one hospital admission. The remaining patients included 33 with variceal bleeding which had stopped and 39 who were bleeding from another source. Sixty-six of the former group of 71 patients were referred for emergency injection sclerotherapy. These 66 patients were followed prospectively to August 1980, and had 137 episodes of endoscopically proven variceal bleeding requiring Sengstaken tube control followed by injection sclerotherapy during 93 separate hospital admissions. Definitive control of hemorrhage was achieved in 95% the patients admitted to the hospital (single injection 70%; two or three injections 22%). The death rate per hospital admission was 28%. No patient died of continued variceal bleeding, and exsanguinating variceal hemorrhage no longer poses a major problem at our hospital. The combined use of initial Sengstaken tube tamponade followed by injection sclerotherapy has simplified emergency treatment in the group of patients who continue to bleed actively from esophageal varices, despite initial conservative treatment.
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Keller FS, Rösch J. Value of angiography in diagnosis and therapy of acute upper gastrointestinal hemorrhage. Dig Dis Sci 1981; 26:78S-89S. [PMID: 6765055 DOI: 10.1007/bf01300813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Keller FS, Rösch J, Dotter CT, Jendrzejewski JW. Embolization in the treatment of bleeding gastroesophageal varices. Semin Roentgenol 1981; 16:103-15. [PMID: 6972098 DOI: 10.1016/0037-198x(81)90046-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Hunt TH, Gelfand DW. Complications of gastrointestinal radiologic procedures: III. Complications of diagnostic and interventional angiography. GASTROINTESTINAL RADIOLOGY 1981; 6:57-67. [PMID: 7021299 DOI: 10.1007/bf01890222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Gelfand DW, Ott DJ, Hunt TH. Gastrointestinal Complications of Radiologic Procedures. RADIOLOGY OF IATROGENIC DISORDERS 1981. [DOI: 10.1007/978-1-4612-5853-7_4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Williams D, Goldin D, Willing R, Mackinnon M. Transhepatic embolisation of gastro-oesophageal varices in the management of variceal haemorrhage. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1980; 10:608-10. [PMID: 6971091 DOI: 10.1111/j.1445-5994.1980.tb04240.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The difficulty of controlling variceal haemorrhage has led to the recent development of methods designed to sclerose the bleeding vessels. This study describes the application of percutaneous transhepatic portal catheterization with embolisation and sclerosis of varices in eight consecutive patients admitted with bleeding oesophago-gastric varices. Portal hypertension was documented and varices demonstrated in each case. Bleeding ceased rapidly in seven patients, two patients rebled 1-3 weeks after the procedure, and five patients were subsequently discharged from hospital. In no instance was death related to continued gastrointestinal haemorrhage. Initial experience with transheptic embolisation of bleeding oesophago-gastric varices indicates that this technique is effective in controlling variceal haemorrhage.
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Abstract
Percutaneous transhepatic embolization of varices (PTEV) has proved to be effective in the control variceal bleeding, particularly in Child's Class C Category patients whose bleeding was not adequately controlled by pitressin perfusions. PTEV, using Gel-Foam soaked in sodium tetradecyl sulfate, controlled acute variceal bleeding in 71--95% of patients and appears to be more effective as an embolizing agent than bucrylate, which controlled 43--57%. Considering the poor condition of the patients particularly during acute bleeding episodes, PTEV is a relatively safe therapeutic procedure that buys time for the surgeons to perform a decompressive shunt electively as definitive surgery. A one-year recurrent bleeding rate of 30% and a two year recurrence of 37.5% was noted. Thus, for long term control of variceal bleeding, a surgical decompressive shunt is recommended in addition to PTEV.
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Hoevels J, Lunderquist A, Owman T. Complications of percutaneous transhepatic catheterization of the portal vein and its tributaries. ACTA RADIOLOGICA: DIAGNOSIS 1980; 21:593-601. [PMID: 6969973 DOI: 10.1177/028418518002100505] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The complications of percutaneous transhepatic catheterization of the portal vein and its tributaries were assessed in 406 patients in whom 440 examinations had been performed and 8 unsuccessful attempts. Clinically relevant complications consisting of abdominal or external hemorrhage occurred in 24 cases with fatal outcome in 3. Complications involving the right pleural space occurred in 13 patients: collection of ascitic fluid in 6, bile effusion in 5 and bleeding in 2. Laparotomy was needed in 7 cases due to intraabdominal hemorrhage. The gallbladder was unintentionally punctured in 4 cases. Furthermore, a variety of minor complications of little clinical significance, such as extravasation of contrast medium, subintimal injection of contrast medium and minor intrahepatic hematomas, were observed.
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Abstract
Previous reports from this hospital in 1958 and 1967 have revealed that esophageal tamponade is a relatively dangerous type of treatment. Other investigators have been able to avoid many of the hazards of this technique. We have again assessed our results in 50 episodes of esophageal tamponade in bleeding esophageal varices in 39 patinets. Thirty-seven had alcoholic cirrhosis, one Wilson's disease, and one portal vein thrombosis. The diagnosis of variceal hemorrhage was established by endoscopy or angiography in virtually all. The great majority (86%) had had unsuccessful infusions of vasopressin previously. The Sengstaken-Blakemore tube (SBT) was used in 41 and the Linton tube (LT) in nine. Hemorrhage was controlled for at least 24 consecutive hours in 20 episodes (40%). Ninety percent of the patients died. Rupture of the esophagus following inflation of the gastric balloon in the esophagus caused three deaths (8%). Major nonfatal complications such as aspiration pneumonia occurred on five other occasions. Although the complications of esophageal tamponade were greatly reduced from our previous series, the efficacy of esophageal tamponade also decreased. There were no significant differences in the efficacy or complications of the SBT and LT. The high mortality and complication rates are still discouraging. We believe that the role of esophageal tamponade in the treatment of hemorrhage from varices is a secondary one.
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Matory WE, Sedgwick CE, Rossi RL. Nonshunting procedures in management of bleeding esophageal varices. Surg Clin North Am 1980; 60:281-95. [PMID: 6992306 DOI: 10.1016/s0039-6109(16)42081-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Goldin AR, Thomson KR. Local experience with transhepatic portal catheterization. AUSTRALASIAN RADIOLOGY 1980; 24:38-43. [PMID: 6967723 DOI: 10.1111/j.1440-1673.1980.tb02153.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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36
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Skjennald A, Klevmark B, Stenwig JT. Transcatheter embolization of the renal artery with bucrylate in renal carcinoma. ACTA RADIOLOGICA: DIAGNOSIS 1980; 21:215-9. [PMID: 7424555 DOI: 10.1177/028418518002102a12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In 5 patients with large renal carcinomas Bucrylate was injected into the renal artery. One to 3.5 ml Bucrylate were required to obtain occlusion of the arteries. At operation 14 to 38 days later the arteries were still occluded. One patient developed pulmonary embolism, other complications were of less importance. The main indication for the procedure is very large, highly vascularized carcinomas in the upper part of the kidney. Bucrylate seems to be a suitable embolus inducing agent.
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PEREIRAS RAUL, SCHIFF EUGENE, BARKIN JAIME, HUTSON DUANE. THE ROLE OF INTERVENTIONAL RADIOLOGY IN DISEASES OF THE HEPATOBILIARY SYSTEM AND THE PANCREAS. Radiol Clin North Am 1979. [DOI: 10.1016/s0033-8389(22)01899-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Hoevels J, Lunderquist A, Tylén U, Simert G. Porto-systemic collaterals in cirrhosis of the liver. Selective percutaneous transhepatic catheterization of the portal venous system in portal hypertension. ACTA RADIOLOGICA: DIAGNOSIS 1979; 20:865-77. [PMID: 546069 DOI: 10.1177/028418517902000602] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In 93 patients with cirrhosis of the liver and portal venous hypertension the main tributaries of the portal vein were examined by percutaneous transhepatic catheterization. The appearance and degree of porto-systemic collaterals were analysed. Esophageal varices were demonstrated in 82 patients. No correlation was found between the portal venous pressure and the extent of porto-systemic communications.
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Henderson JM, Buist TA, MacPherson AI. Percutaneous transhepatic occlusion for bleeding oesophageal varices. Br J Surg 1979; 66:569-71. [PMID: 314826 DOI: 10.1002/bjs.1800660815] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Using the technique described by Lunderquist et al. (1977), transhepatic injection of oesophageal varices has been performed under local anaesthesia in 9 patients with portal hypertension (11 procedures). On 2 occasions it was not possible to enter the left gastric vein. Bleeding resumed within 2 days of radiologically satisfactory occlusion in 2 patients and at 1, 3, 4 and 10 months after 4 procedures in 3 patients. Other complications included portal vein thrombosis, gross ascites and right pleural effusion. There were 2 hospital deaths, both in alcoholic patients with poor hepatic function. In spite of the apparently high morbidity we consider that there is a place for this technique in tiding over patients who are bleeding from oesophageal varices and are medically unsuitable for any surgical procedure.
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Pond GD, Ovitt TW. Therapeutic applications of angiography: state of the art. Curr Probl Diagn Radiol 1979; 8:1-55. [PMID: 380917 DOI: 10.1016/s0363-0188(79)80004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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41
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Passariello R, Rossi P, Simonetti G, Ciolina A, Rovighi L. Emergency transhepatic obliteration of bleeding varices. CARDIOVASCULAR RADIOLOGY 1979; 2:97-106. [PMID: 312137 DOI: 10.1007/bf02575369] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Transhepatic obliteration of gastroesophageal varices was performed in 18 actively bleeding patients. The success of the procedure was related to the complete obliteration of the varices, as demonstrated by their disappearance at angiography. In 13 of the 14 patients in whom obliteration was complete, bleeding did not recur. Three of the 13 died of hepatic insufficiency within 18 days of embolization, and three refused surgery and were lost to follow-up. The remaining seven patients had portacaval or mesocaval shunts, and are doing well at a follow-up of 12 months. Transhepatic obliteration has, therefore, proved to be an effective emergency procedure in patients who will be acceptable surgical candidates at a later date.
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Feld RS, Levin DC, Grey DP, Mee RB. Transcatheter embolization for control of bleeding following pleurectomy. Ann Thorac Surg 1979; 27:363-6. [PMID: 454007 DOI: 10.1016/s0003-4975(10)63317-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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43
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Freeny PC, Kidd R. Forums in gastrointestinal roentgenology: transhepatic portal venography and selective obliteration of gastroesophageal varices using isobutyl 2-cyanoacrylate (bucrylate). Dig Dis Sci 1979; 24:321-30. [PMID: 88316 DOI: 10.1007/bf01296550] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Five patients with Child's class C alcoholic cirrhosis and actively bleeding gastroesophageal varices underwent transhepatic portal venography and selective obliteration of varices with isobutyl 2-cyanoacrylate (Bucrylate). Temporary control of bleeding was obtained in four patients and complete control in one. This new technique is best utilized to stop active variceal hemorrhage in patients who are not candidates for portasystemic shunt surgery or to control bleeding while the patient's general medical condition is improved to decrease the risk of subsequent shunt surgery.
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