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Ordobazari J, Pfeiffer C, Wang-Leandro A, Volk HA, Karbe GT. Ultrasound- and fluoroscopic-guided, percutaneous cholecystostomy drain placement in canine cadavers, a feasibility and safety study. Front Vet Sci 2025; 12:1549221. [PMID: 40417358 PMCID: PMC12100624 DOI: 10.3389/fvets.2025.1549221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Accepted: 03/25/2025] [Indexed: 05/27/2025] Open
Abstract
Objective To evaluate the feasibility and safety of placing cholecystostomy drains percutaneously under ultrasound and fluoroscopy guidance. Study design Experimental cadaveric study. Animals Ten canine cadavers. Methods Placement of two different locking loop drain systems was tested, an 8F pediatric-nephrostomy (Boston Scientific PNPAS) and a 6.5F SUB-nephrostomy (Norfolk Vet Products). The drains were placed into the gallbladders using a Seldinger-technique under ultrasound and fluoroscopic guidance. After placement, CT-scans were performed to assess drain position, leakage and organ injuries. Anatomic examination was performed to identify and grade iatrogenic injury to the abdominal and thoracic organs. Leak pressures were measured using a water manometer. Procedure time, volume injected and pressure measurements before and at the time of leakage were recorded. Results Drain placement into the gallbladder was confirmed by ultrasound and fluoroscopy in 5/5 pediatric-nephrostomy and 0/5 SUB-nephrostomy drains. Mean placement time was 10 min (range 7-12 min) for pediatric-nephrostomy drains. CT-scans confirmed drain placement in 4/5 pediatric-nephrostomy drains, one drain had dislodged. Free abdominal contrast was observed in 4/5 dogs with pediatric-nephrostomy. Drains were placed through the 5th to 10th intercostal space. Anatomic examination showed perforation of the pleural cavity (3/10) for drains placed through the 5th, 7th, and 10th intercostal spaces. Drains passed through the liver parenchyma in the same three dogs. The remaining seven dogs had no organ damage. Pressure testing was performed in the pediatric-nephrostomy drains (4/5). Leakage occurred at a pressure of 4, 9, 12 and 18 cm H2O. Leaks were seen at other sites of the gallbladder prior to leaking at the drain entrance point. Conclusion Percutaneous cholecystostomy drain placement is feasible in dogs depending on the drain and technique. Risk of pleural space injury must be considered when performing this method. Further studies are needed to establish a safe, standardized percutaneous cholecystostomy technique. Clinical significance Imaging-guided, percutaneous cholecystostomy drain placement with the tested method is feasible depending on the drain type. Safety concerns must be addressed prior to clinical application.
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Jeong CY, Noh BJ, Na DG. Feasibility, efficacy, and safety of core needle biopsy as a first-line method for cervical lymphadenopathy. Eur Radiol 2025; 35:2519-2529. [PMID: 39500801 DOI: 10.1007/s00330-024-11174-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 09/01/2024] [Accepted: 10/01/2024] [Indexed: 04/25/2025]
Abstract
OBJECTIVES This study aimed to determine the feasibility, diagnostic efficacy, and safety of ultrasound-guided core needle biopsy (CNB) as a first-line biopsy method for cervical lymphadenopathy of non-thyroid origin. MATERIALS AND METHODS This retrospective cohort study included consecutive patients with cervical lymphadenopathy in whom US-guided CNB was used as the first-line biopsy method for cervical lymph nodes (LNs) of presumed non-thyroid origin. The coaxial CNB technique was routinely used, while the tilting and hydrodissection CNB techniques were selectively employed for small high-risk LNs. The primary endpoint of this study was the diagnostic efficacy of CNB, evaluated by the rate of inconclusive results (nondiagnostic and indeterminate) and diagnostic accuracy (criterion 1: malignant results; criterion 2: malignant or indeterminate result). The secondary outcomes included the feasibility and safety of CNB, assessed based on the technical success rate and complication rate, respectively. RESULTS The rates of nondiagnostic, indeterminate, and inconclusive results were 0.7%, 3.4%, and 4.1%, respectively. The sensitivity, specificity, and accuracy of CNB for malignant LNs were 96.2%, 100%, and 97.8%, respectively, with criterion 1, and these values were all 99.8% with criterion 2. The technical success rate of CNB was 99.3%. There were no major complications and 7 cases (0.6%) of minor complications (asymptomatic hematomas). CONCLUSION CNB was technically feasible, effective, and safe as a first-line biopsy method for cervical lymphadenopathy of non-thyroid origin with high diagnostic accuracy for malignant nodal disease. KEY POINTS Question The role of US-guided CNB as a first-line biopsy method for cervical LNs has not yet been verified and established. Findings US-guided CNB, as a first-line method, demonstrated a high technical success rate and diagnostic accuracy for malignant nodes, with few minor complications. Clinical relevance US-guided CNB can be used as an effective first-line biopsy method for cervical lymphadenopathy and will enable accurate diagnosis of malignant LNs.
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Affiliation(s)
- Chan Yeop Jeong
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Byeong-Joo Noh
- Department of Pathology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
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Antalek M, Patel ME, Knight GM, Malik A, Husnain A, Stiff K, Talwar A, Reiland A, Nemcek AA, Salem R, Riaz A. Adverse Events After Percutaneous Transhepatic Biliary Drainage: A 10-Year Retrospective Analysis. J Vasc Interv Radiol 2025; 36:564-572.e1. [PMID: 39725055 DOI: 10.1016/j.jvir.2024.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 11/26/2024] [Accepted: 12/14/2024] [Indexed: 12/28/2024] Open
Abstract
PURPOSE To determine the adverse event (AE) rates and profiles associated with percutaneous transhepatic biliary drainage (PTBD) and to identify risk factors for their occurrence. MATERIALS AND METHODS This single-center retrospective study included 2,310 PTBD (right-sided, 1,164; left-sided, 966; bilateral, 180) interventions for biliary obstruction (benign/malignant) in 449 patients between 2010 and 2020. Patients with percutaneous cholecystostomy alone were excluded. There were 455 initial drain placements (66 with cholangioplasty) and 1,855 exchanges (202 with cholangioplasty). Stents were placed in 163 procedures (metal, 156; plastic, 86). Demographic and procedural variables were assessed using multivariate logistic regression. RESULTS A total of 745 AEs were recorded. The 3 most common AEs were pericatheter bile leak (331/745, 44.4%), catheter occlusion (110/745, 14.7%), and drain dislodgement (103/745, 13.8%). There was a significantly higher overall AE rate among patients with malignant biliary obstruction than among those with benign biliary obstruction (29.8% vs. 17.6%; odds ratio [OR], 1.57 [1.13-2.18]; P = .006). Intraprocedural cholangioplasty was associated with a decreased AE rate for initial drains and overall procedures (OR, 0.48 [0.25-0.90]; P = .022, and OR, 0.63 [0.45-0.89]; P = .009). Finally, a right-sided drain was associated with an increased overall AE rate for initial drains and overall procedures (OR, 1.62 [1.02-2.55]; P = .039, and OR, 1.43 [1.05-1.91]; P = .017). CONCLUSIONS Malignant obstruction and right-sided drains are associated with a higher risk of PTBD-related AEs, whereas intraprocedural cholangioplasty reduces risk. These findings offer insights into how this high-impact procedure can be performed more safely and effectively.
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Affiliation(s)
- Matthew Antalek
- Department of Radiology, Section of Vascular and Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Muhammed E Patel
- Department of Radiology, Section of Vascular and Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Gabriel M Knight
- Department of Radiology, Section of Vascular and Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Asad Malik
- Department of Radiology, Section of Vascular and Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Ali Husnain
- Department of Radiology, Section of Vascular and Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Kristine Stiff
- Department of Radiology, Section of Vascular and Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Abhinav Talwar
- Department of Radiology, Section of Vascular and Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Allison Reiland
- Department of Radiology, Section of Vascular and Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Albert A Nemcek
- Department of Radiology, Section of Vascular and Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Riad Salem
- Department of Radiology, Section of Vascular and Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Ahsun Riaz
- Department of Radiology, Section of Vascular and Interventional Radiology, Northwestern University, Chicago, Illinois.
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Liang X, Jiang B, Ji Y, Xu Y, Lv Y, Qin S, Huo L, Zhang H, Liu H, Shi T, Luo Y. Complications of ultrasound-guided thermal ablation of thyroid nodules and associated risk factors: an experience from 9667 cases. Eur Radiol 2025; 35:2307-2319. [PMID: 39174654 DOI: 10.1007/s00330-024-11023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 06/07/2024] [Accepted: 08/06/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES To evaluate the safety of ultrasound-guided thermal ablation (UGTA) for thyroid nodules (TNs) by analysing complications and related risks. MATERIALS AND METHODS This retrospective, single-centre study reviewed patients who underwent UGTA (microwave or radiofrequency ablation) between January 2018 and March 2023. The incidence of complications was recorded and assessed during and immediately after ablation,1-3 h later, and at 1 month, 3 months, and 6 months. Univariate and multivariate analyses were performed to identify risk factors for hoarseness and haemorrhagic complications. RESULTS We reviewed 9667 cases in this study. Overall, 4494 (46.49%) cases underwent microwave ablation, while 5173 (53.51%) cases underwent radiofrequency ablation. The overall complication rate was 4.43%. The incidence of major complications was 1.94% (haemorrhage, 1.32%; hoarseness, 0.54%; and symptomatic aseptic necrosis, 0.08%). The incidence of minor complications was 2.45%. A large nodule volume, radiofrequency ablation, hyper-enhancing nodules, benign nodules, higher preoperative blood pressure, hyperthyroidism, and higher ablation power were independent risk factors for haemorrhage. Dorsal nodules and a higher ablation power were independent risk factors for hoarseness. All complications were resolved. CONCLUSION This study suggests that UGTA is a safe treatment for TNs. Several risk factors for haemorrhage and hoarseness should be considered before performing UGTA. Different ablation modalities should be considered for patients with different conditions. CLINICAL RELEVANCE STATEMENT Thermal ablation may be a safe treatment for eligible patients with TNs. KEY POINTS We analysed the complications and risk factors associated with UGTA in 9667 cases. The complication rate was 4.43%; 1.94% were major complications. Risk factors of haemorrhage and hoarseness should be considered. UGTA was a safe method for the treatment of TNs.
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Affiliation(s)
- Xi Liang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bo Jiang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yongjiao Ji
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yanna Xu
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yanting Lv
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Si Qin
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lanlan Huo
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Huimiao Zhang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hongrui Liu
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Tongming Shi
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
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Azami T, Takano Y, Tamai N, Noda J, Yamawaki M, Niiya F, Maruoka N, Nishimoto F, Ishihara A, Nagahama M. Outcomes of percutaneous transhepatic gallbladder drainage versus percutaneous transhepatic biliary drainage for obstructive jaundice. PLoS One 2025; 20:e0310469. [PMID: 39993017 PMCID: PMC11849854 DOI: 10.1371/journal.pone.0310469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Accepted: 12/17/2024] [Indexed: 02/26/2025] Open
Abstract
Percutaneous transhepatic gallbladder drainage (PTGBD) is an alternative to percutaneous transhepatic biliary drainage (PTBD) for cases with obstructive jaundice in which the bile duct obstruction is below the confluence of the cystic ducts. This retrospective study aimed to evaluate the usefulness of PTGBD and PTBD in patients with obstructive jaundice. We recruited patients who had undergone percutaneous biliary drainage for acute cholangitis and obstructive jaundice at two institutions between January 2017 and March 2024. In principle, PTBD was the first choice. PTGBD was selected for cases where the intrahepatic bile duct diameter was ≤ 5 mm or ≥ 6 mm with significant respiratory-related variability of the positioning of the bile ducts. In other cases, PTBD was chosen. Fifty-five patients were included in this analysis. However, patients with intrahepatic or hilar bile duct stenosis, post choledocholithiasis, complex cholecystitis, total bilirubin levels of < 2.0 mg/dL, and uncorrectable bleeding tendency and those who had undergone the procedure and later discontinued without puncture were excluded. The technical success rates, clinical success rates, and complication rates of the procedure were evaluated. The technical success rates were 96.3% (26/27) and 82.1% (23/28) in the PTGBD and PTBD groups, respectively. The clinical success rates were 85.2% (23/27) and 67.9% (19/28) in the PTGBD and PTBD groups, respectively. The complication rates were 18.5% (5/27) and 25.0% (7/28) in the PTGBD and PTBD groups, respectively. No serious complications were observed in either group. Hence, the two groups did not significantly differ in any of the endpoints. The outcomes of PTGBD were comparable to those of PTBD in patients with obstructive jaundice. Hence, PTGBD is a reasonable treatment option for cases of obstructive jaundice in which PTBD is not feasible.
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Affiliation(s)
- Tetsushi Azami
- Department of Medicine, Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yuichi Takano
- Department of Medicine, Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Naoki Tamai
- Department of Medicine, Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Jun Noda
- Department of Medicine, Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Masataka Yamawaki
- Department of Medicine, Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Fumitaka Niiya
- Department of Medicine, Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Naotaka Maruoka
- Department of Medicine, Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Fumiya Nishimoto
- Department of Medicine, Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Akira Ishihara
- Department of Gastroenterological Surgery, Hitachi Medical Center, Hitachi, Japan
| | - Masatsugu Nagahama
- Department of Medicine, Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
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Morgan MA, DePietro DM, Whorms DS, Pantel AR, Ganeshan D, Goldman IA, Yang J, Khot R. Acalculous cholecystitis- an imaging and therapeutic update. Abdom Radiol (NY) 2024:10.1007/s00261-024-04691-0. [PMID: 39680125 DOI: 10.1007/s00261-024-04691-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 11/02/2024] [Accepted: 11/07/2024] [Indexed: 12/17/2024]
Abstract
In this review, we highlight current understanding of the pathogenesis of acalculous cholecystitis, as well as its key imaging and clinical features. We also review what happens after a diagnosis and outline current interventional methods.
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Affiliation(s)
| | | | - Debra S Whorms
- University of Pennsylvania Health System, Philadelphia, USA
| | | | | | | | - Julie Yang
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rachita Khot
- University of Virginia Health, Charlottesville, USA
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Mnatzakanian AB, Cantwell CP. Adverse Event Rates in Interventional Radiology: A Review of 30 Years of Societal Quality Improvement Publications. Cardiovasc Intervent Radiol 2024; 47:1687-1693. [PMID: 39349782 DOI: 10.1007/s00270-024-03859-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 09/01/2024] [Indexed: 12/06/2024]
Affiliation(s)
| | - Colin P Cantwell
- School of Medicine, University College Dublin, Dublin, Ireland.
- Radiology Department, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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Yung Kim K, Jin Yoon C, Hwan Lee J, Lee CH. Percutaneous treatment of bilioenteric anastomotic strictures: Comparison of long-term outcomes between temporary covered stents and balloon dilation. Eur J Radiol 2024; 181:111816. [PMID: 39531781 DOI: 10.1016/j.ejrad.2024.111816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 09/26/2024] [Accepted: 11/04/2024] [Indexed: 11/16/2024]
Abstract
PURPOSE To compare the long-term outcomes of percutaneous balloon dilation versus temporary covered stent placement in treating benign bilioenteric anastomotic strictures. MATERIALS AND METHODS Eighty-three patients with benign bilioenteric anastomotic stricture from December 2014 to May 2023 were included in the study. Balloon dilation was performed up to 3 times in 46 patients (balloon group) and temporary covered stent placement aiming at spontaneous migration was performed in 23 patients (stent group). Technical and clinical success, primary patency rates, percutaneous transhepatic biliary drainage (PTBD) indwelling times, and complications were compared between the two groups. RESULTS The median follow-up was 963 days for the balloon group and 1151 days for the stent group (p = 0.775). Short-term stricture resolution was achieved in 46 of 60 patients (76.7 %) in the balloon group and in all patients in the stent group. Clinical success was achieved in all patients with short-term stricture resolution. The stent group showed higher primary patency rates (90.2 %, 83.3 %, 74.0 %, and 74.0 % vs. 72.9 %, 56.8 %, 39.7 %, and 39.7 % at 1, 3 5, and 7 years; p = 0.033) and a shorter median PTBD indwelling time (4 days vs. 6 days; p = 0.031) compared to the balloon group. Spontaneous migration of the stent was found in 19 of 23 patients (82.6 %), with a median stent indwelling time of 3 months (range, 3-12 months). CONCLUSION Percutaneous temporary covered stent placement is an effective treatment option for patients with benign bilioenteric anastomotic strictures, offering higher primary patency rates and shorter PTBD indwelling times, compared to balloon dilation over a long-term period.
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Affiliation(s)
- Kun Yung Kim
- Departments of Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, South Korea
| | - Chang Jin Yoon
- Departments of Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, South Korea.
| | - Jae Hwan Lee
- Departments of Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, South Korea
| | - Chong-Ho Lee
- Departments of Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, South Korea
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Neitzel E, Stearns J, Guido J, Porter K, Whetten J, Lammers L, vanSonnenberg E. Iatrogenic vascular complications of non-vascular percutaneous abdominal procedures. Abdom Radiol (NY) 2024; 49:4074-4091. [PMID: 38849536 DOI: 10.1007/s00261-024-04381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE The purpose of this paper is to compile and present all of the reported vascular complications that resulted from common non-vascular abdominal procedures in the literature. Non-vascular procedures include, though are not limited to, percutaneous abscess/fluid collection drainage (PAD), percutaneous nephrostomy (PN), paracentesis, percutaneous transhepatic cholangiography (PTC)/percutaneous biliary drainage (PBD), percutaneous biliary stone removal, and percutaneous radiologic gastrostomy (PG)/percutaneous radiologic gastrojejunostomy (PG-J). By gathering this information, radiologists performing these procedures can be aware of the associated vascular injuries, as well as take steps to minimize risks. METHODS A literature review was conducted using the PubMed database to catalog relevant articles, published in the year 2000 onward, in which an iatrogenic vascular complication occurred from the following non-vascular abdominal procedures: PAD, PN, paracentesis, PTC/PBD, percutaneous biliary stone removal, and PG/PG-J. Biopsy and tumor ablation were deferred from this article. RESULTS 214 studies met criteria for analysis. 28 patients died as a result of vascular complications from the analyzed non-vascular abdominal procedures. Vascular complications from paracentesis were responsible for 19 patient deaths, followed by four deaths from PTC/PBD, three from biliary stone removal, and two from PG. CONCLUSION Despite non-vascular percutaneous abdominal procedures being minimally invasive, vascular complications still can arise and be quite serious, even resulting in death. Through the presentation of vascular complications associated with these procedures, interventionalists can improve patient care by understanding the steps that can be taken to minimize these risks and to reduce complication rates.
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Affiliation(s)
- Easton Neitzel
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA.
| | - Jack Stearns
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jessica Guido
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Kaiden Porter
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jed Whetten
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Luke Lammers
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Eric vanSonnenberg
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
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Scappaticcio L, Ferrazzano P, Di Martino N, Negro R, Deandrea M, Maiorino MI, Caruso P, Di Nuzzo M, Longo M, Docimo G, Papi G, Trimboli P, Esposito K, Bellastella G. Prevalence and Management of Complications of Percutaneous Ethanol Injection for Cystic Thyroid Nodules: A Systematic Review of Literature and Meta-analysis. Thyroid 2024; 34:1068-1081. [PMID: 39030844 DOI: 10.1089/thy.2024.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
Background: We assessed the prevalence of complications from percutaneous ethanol injection (PEI) for benign and cystic thyroid nodules (CTNs) and their management. Methods: We conducted a systematic review with meta-analysis of data from published observational studies on PEI of CTNs. We also included unpublished retrospectively collected data on complications after PEI from all consecutive patients with cytologically benign CTNs who underwent PEI at the Unit of Endocrinology and Metabolic Diseases, AOU University of Campania Luigi Vanvitelli (Naples, Italy) between June 1, 2021, and March 31, 2024. A random effects meta-analysis was performed on the prevalence rate data. Pooled prevalence data were presented with confidence intervals (CIs). The I2 statistic index was used to quantify the heterogeneity. The details of the complications and the management were qualitatively described. Results: The literature search yielded 1189 studies, of which 48 studies were included in the systematic review and meta-analysis, in addition to our institutional experience (3670 CTNs in total). The overall quality of each included study was judged as fair. The prevalence of "Overall" complications of PEI was 32% ([CI 25-40%], I2 92.7%, 967 of 3195 thyroid nodules [TNs]). The prevalence of "Minor" complications of PEI was 32% ([CI 25-40%], I2 92.7%, 952 of 3195 TNs). The prevalence of "Major" complications of PEI was 2% ([CI 1-2%], I2 0%, 22 of 3670 TNs). Sensitivity analyses did not modify the results. The pooled prevalence rate of local pain was 21% (CI [16-27] I2 90.3). Local pain was typically transient and mild, sometimes moderate, and requiring analgesics for few days. The pooled prevalence rate of dysphonia was 1% (CI [1-2], I2 0). Dysphonia was transient and could last from several hours to 12 months after PEI. Conclusions: Complications of PEI for benign and CTNs are relatively common, but most are minor and usually transient, not requiring treatment. Dysphonia was a major complication, but it was uncommon and transient. PEI for CTNs could be considered a generally safe technique.
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Affiliation(s)
- Lorenzo Scappaticcio
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pamela Ferrazzano
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicole Di Martino
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Roberto Negro
- Unit of Endocrinology, Ospedale Vito Fazzi, Lecce, Italy
| | - Maurilio Deandrea
- Center for Thyroid Diseases, Ordine Mauriziano Hospital, Turin, Italy
| | - Maria Ida Maiorino
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Caruso
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Michela Di Nuzzo
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Miriam Longo
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanni Docimo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Pierpaolo Trimboli
- Clinic of Endocrinology and Diabetology, Lugano and Mendrisio Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Katherine Esposito
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Bellastella
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
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11
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Husnain A, Malik A, Caicedo J, Nadig S, Borja-Cacho D, Boike J, Levitsky J, Reiland A, Thornburg B, Keswani R, Ebrahim Patel MS, Aadam A, Salem R, Duarte A, Ganger D, Riaz A. Percutaneous Biliary Interventions via the Modified Hutson Loop in Patients with Biliary-Enteric Anastomoses: A Retrospective Study. Cardiovasc Intervent Radiol 2024; 47:1083-1092. [PMID: 38858255 DOI: 10.1007/s00270-024-03778-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/12/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE This study aimed to present the institutional experience and algorithm for performing biliary interventions in liver transplant patients using the modified Hutson loop access (MHLA) and the impact of percutaneous endoscopy via the MHLA on these procedures. METHODS Over 13 years, 201 MHLA procedures were attempted on 52 patients (45 liver transplants; 24 living and 21 deceased donors) for diagnostic (e.g., cholangiography) and therapeutic (e.g., stent/drain insertion and cholangioplasty) purposes. The most common indications for MHLA were biliary strictures (60%) and bile leaks (23%). Percutaneous endoscopy was used to directly visualize the biliary-enteric anastomosis, diagnose pathology (e.g., ischemic cholangiopathy), and help in biliary hygiene (removing debris/casts/stones/stents) in 138/201 (69%) procedures. Technical success was defined as cannulating the biliary-enteric anastomosis and performing diagnostic/therapeutic procedure via the MHLA. RESULTS The technical success rate was 95% (190/201). The failure rate among procedures performed with and without endoscopy was 2% (3/138) versus 13% (8/63) (P = 0.0024), and the need for new transhepatic access (to aid the procedure) was 12% (16/138) versus 30% (19/63) (P = 0.001). Despite endoscopy, failure in 2% of the cases resulted from inflamed/friable anastomosis (1/3) and high-grade stricture (2/3) obstructing retrograde cannulation of biliary-enteric anastomosis. Major adverse events (bowel perforation and injury) occurred in 1% of the procedures, with no procedure-related mortality. CONCLUSIONS MHLA-based percutaneous biliary intervention is a safe and effective alternative to managing complications after liver transplant. Percutaneous endoscopy via the MHLA improves success rates and may reduce the need for new transhepatic access. Level of Evidence Level 4.
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Affiliation(s)
- Ali Husnain
- Division of Interventional Radiology, Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Asad Malik
- Division of Interventional Radiology, Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Juan Caicedo
- Department of Surgery, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Satish Nadig
- Department of Surgery, Northwestern Memorial Hospital, Chicago, IL, USA
| | | | - Justin Boike
- Department of Medicine, Section of Gastroenterology and Hepatology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Josh Levitsky
- Department of Medicine, Section of Gastroenterology and Hepatology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Allison Reiland
- Division of Interventional Radiology, Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Bartley Thornburg
- Division of Interventional Radiology, Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Rajesh Keswani
- Department of Medicine, Section of Gastroenterology and Hepatology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Muhammed Sufyaan Ebrahim Patel
- Division of Interventional Radiology, Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Aziz Aadam
- Department of Medicine, Section of Gastroenterology and Hepatology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Riad Salem
- Division of Interventional Radiology, Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Andres Duarte
- Department of Medicine, Section of Gastroenterology and Hepatology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Daniel Ganger
- Department of Medicine, Section of Gastroenterology and Hepatology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Ahsun Riaz
- Division of Interventional Radiology, Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
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12
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Deliwala SS, Qayed E. Role of endoscopic-ultrasound-guided biliary drainage with electrocautery-enhanced lumen-apposing metal stent for palliation of malignant biliary obstruction. World J Gastrointest Surg 2024; 16:1981-1985. [PMID: 39087127 PMCID: PMC11287705 DOI: 10.4240/wjgs.v16.i7.1981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/09/2024] [Accepted: 05/24/2024] [Indexed: 07/22/2024] Open
Abstract
In this editorial, we discuss the article by Peng et al in the recent issue of the World Journal of Gastrointestinal Surgery, focusing on the evolving role of endoscopic-ultrasound-guided biliary drainage (EUS-BD) with electrocautery lumen apposing metal stent (LAMS) for distal malignant biliary obstruction. Therapeutic endoscopy has rapidly advanced in decompression techniques, with growing evidence of its safety and efficacy surpassing percutaneous and surgical approaches. While endoscopic retrograde cholangiopancreatography (ERCP) has been the gold standard for biliary decompression, its failure rate approaches 10.0%, prompting the exploration of alternatives like EUS-BD. This random-effects meta-analysis demonstrated high technical and clinical success of over 90.0% and an adverse event rate of 17.5%, mainly in the form of stent dysfunction. Outcomes based on stent size were not reported but the majority used 6 mm and 8 mm stents. As the body of literature continues to demonstrate the effectiveness of this technique, the challenges of stent dysfunction need to be addressed in future studies. One strategy that has shown promise is placement of double-pigtail stents, only 18% received the prophylactic intervention in this study. We expect this to improve with time as the technique continues to be refined and standardized. The results above establish EUS-BD with LAMS as a reliable alternative after failed ERCP and considering EUS to ERCP upfront in the same session is an effective strategy. Given the promising results, studies must explore the role of EUS-BD as first-line therapy for biliary decompression.
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Affiliation(s)
- Smit S Deliwala
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30303, United States
| | - Emad Qayed
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30303, United States
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13
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Patel RK, Alagappan A, Tripathy T, Nayak HK, Pattnaik B, Dutta T, Gupta S, Mohakud S, Naik S, Deep Bag N. Bloody Bile and Rescue Intervention-A Case Series of Post-PTBD Hemorrhagic Complications With a Review of the Literature. J Clin Exp Hepatol 2024; 14:101392. [PMID: 38558862 PMCID: PMC10981119 DOI: 10.1016/j.jceh.2024.101392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Percutaneous transhepatic biliary drainage (PTBD) is a routinely performed interventional radiological procedure. A myriad of complications can occur after PTBD, the most important being hemorrhagic complications that require immediate attention. Hemorrhage following PTBD may result from arterial, portal, or hepatic venous injury. A catheter or pull-back cholangiogram often demonstrates the venous injury. A computed tomogram angiogram aids in identifying bleeding sources and procedural planning. Catheter repositioning, upsizing, or clamping often suffice for minor venous bleeding. However, major venous injury necessitates tract embolization, portal vein embolization, or stent grafting. Arterial injury may lead to significant blood loss unless treated expeditiously. Transarterial embolization is the treatment of choice in such cases. Adequate knowledge about the hemorrhagic complications of PTBD will allow an interventional radiologist to take necessary precautionary measures to reduce their incidence and take appropriate steps in their management. This article entails four different hemorrhagic complications of PTBD and their interventional management. It also discusses the various treatment options to manage different kinds of post-PTBD hemorrhagic complications.
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Affiliation(s)
- Ranjan K. Patel
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Alamelu Alagappan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Taraprasad Tripathy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Hemant K. Nayak
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Bramhadatta Pattnaik
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Tanmay Dutta
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Sunita Gupta
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Nerbadyswari Deep Bag
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar 751019, India
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14
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Dietrich CF, Arcidiacono PG, Bhutani MS, Braden B, Burmester E, Fusaroli P, Hocke M, Ignee A, Jenssen C, Al-Lehibi A, Aljahdli E, Napoléon B, Rimbas M, Vanella G. Controversies in Endoscopic Ultrasound-Guided Biliary Drainage. Cancers (Basel) 2024; 16:1616. [PMID: 38730570 PMCID: PMC11083358 DOI: 10.3390/cancers16091616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
In this 14th document in a series of papers entitled "Controversies in Endoscopic Ultrasound" we discuss various aspects of EUS-guided biliary drainage that are debated in the literature and in practice. Endoscopic retrograde cholangiography is still the reference technique for therapeutic biliary access, but EUS-guided techniques for biliary access and drainage have developed into safe and highly effective alternative options. However, EUS-guided biliary drainage techniques are technically demanding procedures for which few training models are currently available. Different access routes require modifications to the basic technique and specific instruments. In experienced hands, percutaneous transhepatic cholangiodrainage is also a good alternative. Therefore, in this paper, we compare arguments for different options of biliary drainage and different technical modifications.
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Affiliation(s)
- Christoph Frank Dietrich
- Department Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, 3013 Bern, Switzerland
| | - Paolo Giorgio Arcidiacono
- Division of Pancreatobiliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (P.G.A.); (G.V.)
| | - Manoop S. Bhutani
- Department of Gastroenterology Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Barbara Braden
- Medical Department B, University Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany;
| | - Eike Burmester
- Medizinische Klinik I, Sana Kliniken Luebeck, 23560 Luebeck, Germany;
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastrointestinal Unit, University of Bologna/Hospital of Imola, 40126 Bologna, Italy
| | - Michael Hocke
- Medical Department II, Helios Klinikum Meiningen, 98617 Meiningen, Germany;
| | - Andrè Ignee
- Klinikum Würzburg Mitte, Standort Juliusspital, 97074 Würzburg, Germany;
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland, 15441 Strausberg and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, 16816 Neuruppin, Germany;
| | - Abed Al-Lehibi
- Gastroenterology & Hepatology Department, King Fahad Medical City, Riyadh 11525, Saudi Arabia;
| | - Emad Aljahdli
- Faculty of Medicine, King Abdulaziz University, Gastrointestinal Oncology Unit, King Abdul-Aziz University Hospital (KAUH), Jeddah 22252, Saudi Arabia;
| | - Bertrand Napoléon
- Hopital Privé J Mermoz Ramsay Générale de Santé, 69008 Lyon, France;
| | - Mihai Rimbas
- Department of Gastroenterology, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, 050474 Bucharest, Romania;
| | - Giuseppe Vanella
- Division of Pancreatobiliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (P.G.A.); (G.V.)
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15
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Bozic D, Ardalic Z, Mestrovic A, Bilandzic Ivisic J, Alicic D, Zaja I, Ivanovic T, Bozic I, Puljiz Z, Bratanic A. Assessment of Gallbladder Drainage Methods in the Treatment of Acute Cholecystitis: A Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:5. [PMID: 38276039 PMCID: PMC10817550 DOI: 10.3390/medicina60010005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Gallbladder drainage is a treatment option in high-risk surgical patients with moderate or severe acute cholecystitis. It may be applied as a bridge to cholecystectomy or a definitive treatment option. Apart from the simple and widely accessible percutaneous cholecystostomy, new attractive techniques have emerged in the previous decade, including endoscopic transpapillary gallbladder drainage and endoscopic ultrasound-guided gallbladder drainage. The aim of this paper is to present currently available drainage techniques in the treatment of AC; evaluate their technical and clinical effectiveness, advantages, possible adverse events, and patient outcomes; and illuminate the decision-making path when choosing among various treatment modalities for each patient, depending on their clinical characteristics and the accessibility of methods.
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Affiliation(s)
- Dorotea Bozic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
| | - Zarko Ardalic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
| | - Antonio Mestrovic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
| | - Josipa Bilandzic Ivisic
- Department of Gastroenterology, General Hospital of Sibenik-Knin County, Stjepana Radica 83, 22000 Sibenik, Croatia;
| | - Damir Alicic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
| | - Ivan Zaja
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
- University Department of Health Studies, University of Split, Rudjera Boskovica 35, 21000 Split, Croatia
| | - Tomislav Ivanovic
- Department of Abdominal Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia;
| | - Ivona Bozic
- Department of Rheumatology and Immunology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia;
| | - Zeljko Puljiz
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
| | - Andre Bratanic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
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16
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Alswang JM, Mbuguje EM, Naif A, Musa B, Laage Gaupp FM, Ramalingam V. Assessment of Required Patient Travel to Receive Interventional Radiology Services in the Resource-Limited Setting of Tanzania. J Vasc Interv Radiol 2023; 34:2213-2217. [PMID: 37619942 DOI: 10.1016/j.jvir.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/19/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023] Open
Abstract
This study aimed to evaluate the geographic patient profile of a country's first interventional radiology (IR) service in sub-Saharan Africa. From October 2018 to August 2022, travel time (1,339 patients) and home region (1,184 patients) were recorded from 1,434 patients who underwent IR procedures at Tanzania's largest referral center. Distances traveled by road were calculated from the administrative capital of each region using a web mapping platform (google.com/maps). The effect of various factors on distance and time traveled were assessed. Patients from all 31 regions in Tanzania underwent IR procedures. The mean and maximum calculated distance traveled by patients were 241.6 km and 1,387 km, respectively (Sk2 = 1.66); 25.0% of patients traveled for over 6 hours for their procedure. Patients traveled furthest for genitourinary procedures (mean = 293.4 km) and least for angioplasty and stent placement (mean = 123.9 km) (P < .001). To increase population access and reduce travel times, geographic data should be used to decentralize services.
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Affiliation(s)
| | - Erick M Mbuguje
- Department of Radiology, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | - Azza Naif
- Department of Radiology, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | - Balowa Musa
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Fabian M Laage Gaupp
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Vijay Ramalingam
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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17
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Yoon SB, Jeon TY, Moon SH, Shin DW, Park JW, Kim SE, Kim MJ. Effectiveness and complication rates of percutaneous transhepatic fluoroscopy-guided management of common bile duct stones: a single-arm meta-analysis. Eur Radiol 2023; 33:7398-7407. [PMID: 37326663 DOI: 10.1007/s00330-023-09846-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To perform a systematic review and meta-analysis to determine the success and complication rate of percutaneous transhepatic fluoroscopy-guided management (PTFM) for the removal of common bile duct stones (CBDS). METHODS A comprehensive literature search of multiple databases was conducted to identify original articles published between January 2010 and June 2022, reporting the success rate of PTFM for the removal of CBDS. A random-effect model was used to summarize the pooled rates of success and complications with 95% confidence intervals (CIs). RESULTS Eighteen studies involving 2554 patients met the inclusion criteria and were included in the meta-analysis. Failed or infeasible endoscopic management was the most common indication of PTFM. The meta-analytic summary estimates of PTFM for the removal of CBDS were as follows: rate of overall stone clearance 97.1% (95% CI, 95.7-98.5%); stone clearance at first attempt 80.5% (95% CI, 72.3-88.6%); overall complications 13.8% (95% CI, 9.7-18.0%); major complications 2.8% (95% CI, 1.4-4.2%); and minor complications 9.3% (95% CI, 5.7-12.8%). Egger's tests showed the presence of publication bias with respect to the overall complications (p = 0.049). Transcholecystic management of CBDS had an 88.5% pooled rate for overall stone clearance (95% CI, 81.2-95.7%), with a 23.0% rate for complications (95% CI, 5.7-40.4%). CONCLUSION The systematic review and meta-analysis answer the questions of the overall stone clearance, clearance at first attempt, and complication rate of PTFM by summarizing the available literature. Percutaneous management could be considered in cases with failed or infeasible endoscopic management of CBDS. CLINICAL RELEVANCE STATEMENT This meta-analysis highlights the excellent stone clearance rate achieved through percutaneous transhepatic fluoroscopy-guided removal of common bile duct stones, potentially influencing clinical decision-making when endoscopic treatment is not feasible. KEY POINTS • Percutaneous transhepatic fluoroscopy-guided management of common bile duct stones had a pooled rate of 97.1% for overall stone clearance and 80.5% for clearance at the first attempt. • Percutaneous transhepatic management of common bile duct stones had an overall complication rate of 13.8%, including a major complication rate of 2.8%. • Percutaneous transcholecystic management of common bile duct stones had an overall stone clearance rate of 88.5% and a complication rate of 23.0%.
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Affiliation(s)
- Seung Bae Yoon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Tae Yeon Jeon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung-Hoon Moon
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-Ro 170 Beon-Gil, Dongan-Gu, Anyang, Gyeonggi-Do, 14068, South Korea.
| | - Dong Woo Shin
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-Ro 170 Beon-Gil, Dongan-Gu, Anyang, Gyeonggi-Do, 14068, South Korea
| | - Ji Won Park
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-Ro 170 Beon-Gil, Dongan-Gu, Anyang, Gyeonggi-Do, 14068, South Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-Ro 170 Beon-Gil, Dongan-Gu, Anyang, Gyeonggi-Do, 14068, South Korea
| | - Min-Jeong Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
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18
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Arkoudis NA, Moschovaki-Zeiger O, Reppas L, Grigoriadis S, Alexopoulou E, Brountzos E, Kelekis N, Spiliopoulos S. Percutaneous cholecystostomy: techniques and applications. Abdom Radiol (NY) 2023; 48:3229-3242. [PMID: 37338588 DOI: 10.1007/s00261-023-03982-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
Acute cholecystitis (AC) is a critical condition requiring immediate medical attention and treatment and is one of the most frequently encountered acute abdomen emergencies in surgical practice, requiring hospitalization. Laparoscopic cholecystectomy is considered the favored treatment for patients with AC who are fit for surgery. However, in high-risk patients considered poor surgical candidates, percutaneous cholecystostomy (PC) has been suggested and employed as a safe and reliable alternative option. PC is a minimally invasive, nonsurgical, image-guided intervention that drains and decompresses the gallbladder, thereby preventing its perforation and sepsis. It can act as a bridge to surgery, but it may also serve as a definitive treatment for some patients. The goal of this review is to familiarize physicians with PC and, more importantly, its applications and techniques, pre- and post-procedural considerations, and adverse events.
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Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece.
| | - Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
- Interventional Radiology Department, Bioclinic General Hospital of Athens, Marinou Geroulanou 15, 115 24, Athens, Greece
| | - Stavros Grigoriadis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Efthymia Alexopoulou
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
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19
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Canakis A, Baron TH. Therapeutic Endoscopic Ultrasound: Current Indications and Future Perspectives. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:4-18. [PMID: 37818395 PMCID: PMC10561320 DOI: 10.1159/000529089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/26/2022] [Indexed: 10/12/2023]
Abstract
The transcendence of endoscopic ultrasound (EUS) from diagnostic to therapeutic tool has revolutionized management options in the field of gastroenterology. Through EUS-guided methods, pancreaticobiliary obstruction can now be utilized as an alternative to surgical and percutaneous approaches. This modality also allows for gallbladder drainage in patients who are not ideal operative candidates. By utilizing its unique imaging capabilities, EUS also allows for drainage access points in cases of gastric outlet obstruction as well as windows to ablate pancreatic cystic lesions. As technical progress continues to evolve, interventional gastroenterology continues to push the envelope of minimally invasive therapeutic procedures in a multidisciplinary setting. In this comprehensive review, we set out to describe current indications and innovations through EUS.
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Affiliation(s)
- Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Todd H. Baron
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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20
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Ongen G, Nas OF, Hacikurt K, Dundar HZ, Ozkaya G, Kaya E, Hakyemez B. Internal versus external biliary drainage in malignant biliary obstructions: is there a difference in the rate of infection? Acta Radiol 2023; 64:2501-2505. [PMID: 37611191 DOI: 10.1177/02841851231187078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND Percutaneous biliary drainage is a frequently used method to provide biliary decompression in patients with biliary obstruction. PURPOSE To investigate the between drainage type and infection risk in patients treated with internal-external and external biliary drainage catheterization for malignant biliary obstruction. MATERIAL AND METHODS A total of 410 patients with malignant biliary obstruction who underwent internal-external or external biliary drainage catheterization between January 2012 and October 2016 were retrospectively evaluated. We investigated the correlation between percutaneous biliary drainage technique and infection frequency by evaluating patients with clinical findings, bile and blood cultures, complete blood counts, and blood biochemistry. RESULTS There was no statistically significant difference between the selected patient groups (internal-external or external biliary drainage catheter placed) in terms of age, sex, primary diagnosis, receiving chemotherapy, catheter sizes, and outpatient-patient status. After catheterization, catheter-related infection was observed in 49 of 216 (22.7%) patients with internal-external and 18 of 127 (14.2%) patients with external biliary drainage catheters, according to the defined criteria. There was no difference in infection rate after the biliary drainage in the two groups (P > 0.05). There was also no difference concerning frequently proliferating microorganisms in bile cultures. CONCLUSION Internal-external biliary drainage catheter placement does not bring an additional infection risk for uninfected cholestatic patients whose obstruction could be passed easily in the initial drainage.
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Affiliation(s)
- Gokhan Ongen
- School of Medicine, Department of Radiology, Bursa Uludag University, Bursa, Turkey
| | - Omer Fatih Nas
- School of Medicine, Department of Radiology, Bursa Uludag University, Bursa, Turkey
| | - Kadir Hacikurt
- Department of Radiology, Eastbourne District General Hospital, East Sussex, England
| | - Halit Ziya Dundar
- Department of General Surgery, Bursa Medicana Hospital, Bursa, Turkey
| | - Guven Ozkaya
- School of Medicine, Department of Biostatistics, Bursa Uludag University, Bursa, Turkey
| | - Ekrem Kaya
- School of Medicine, Department of General Surgery, Bursa Uludag University, Bursa, Turkey
| | - Bahattin Hakyemez
- School of Medicine, Department of Radiology, Bursa Uludag University, Bursa, Turkey
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21
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Iwamoto T, Suda T, Inoue T, Nozaki Y, Mizumoto R, Arimoto Y, Ohta T, Yamaguchi S, Ito Y, Hagiwara H. Postoperative bleeding after percutaneous transhepatic gallbladder drainage and aspiration in patients receiving antithrombotic therapy. PLoS One 2023; 18:e0288463. [PMID: 37594942 PMCID: PMC10437875 DOI: 10.1371/journal.pone.0288463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 06/27/2023] [Indexed: 08/20/2023] Open
Abstract
This study aimed to investigate the bleeding risk associated with percutaneous transhepatic gallbladder interventions in patients with acute cholecystitis receiving antithrombotic therapy. In this retrospective study, 194 consecutive patients who underwent percutaneous transhepatic gallbladder interventions for acute cholecystitis between April 2011 and April 2021 were enrolled. Patients were sorted into four groups: no prior antithrombotic therapy, discontinued antithrombotic drugs, single antithrombotic drug continued perioperatively, and multiple antithrombotic drugs continued perioperatively. The risk of postoperative bleeding after percutaneous transhepatic gallbladder interventions was evaluated via multivariate logistic regression analysis. Of the 116 (59.8%) patients receiving antithrombotic therapy, 32 (16.5%) discontinued antithrombotic drugs before their respective procedure, 50 (25.8%) continued a single antithrombotic drug, and 34 (17.5%) continued multiple antithrombotic drugs during the perioperative period. The rates of significant and severe bleeding were 10.3% (20/194) and 3.1% (6/194), respectively. The rate of significant bleeding was significantly higher in patients who continued multiple antithrombotic drugs than in patients who received no prior antithrombotic therapy (P = 0.006). In the multivariate logistic regression analysis, the continuation of multiple antithrombotic drugs during the perioperative period was a risk factor for significant bleeding after percutaneous transhepatic gallbladder interventions. In conclusion, the perioperative continuation of multiple antithrombotic drugs is a risk factor for postoperative bleeding after percutaneous transhepatic gallbladder interventions.
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Affiliation(s)
- Takayuki Iwamoto
- Department of Gastroenterology and Hepatology, Kansai Rosai Hospital, Hyogo, Japan
| | - Takahiro Suda
- Department of Gastroenterology and Hepatology, Kansai Rosai Hospital, Hyogo, Japan
| | - Takanori Inoue
- Department of Gastroenterology and Hepatology, Kansai Rosai Hospital, Hyogo, Japan
| | - Yasutoshi Nozaki
- Department of Gastroenterology and Hepatology, Kansai Rosai Hospital, Hyogo, Japan
| | - Rui Mizumoto
- Department of Gastroenterology and Hepatology, Kansai Rosai Hospital, Hyogo, Japan
| | - Yuki Arimoto
- Department of Gastroenterology and Hepatology, Kansai Rosai Hospital, Hyogo, Japan
| | - Takashi Ohta
- Department of Gastroenterology and Hepatology, Kansai Rosai Hospital, Hyogo, Japan
| | - Shinjiro Yamaguchi
- Department of Gastroenterology and Hepatology, Kansai Rosai Hospital, Hyogo, Japan
| | - Yoshiki Ito
- Department of Gastroenterology and Hepatology, Kansai Rosai Hospital, Hyogo, Japan
| | - Hideki Hagiwara
- Department of Gastroenterology and Hepatology, Kansai Rosai Hospital, Hyogo, Japan
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22
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Arkoudis NA, Moschovaki-Zeiger O, Grigoriadis S, Palialexis K, Reppas L, Filippiadis D, Alexopoulou E, Brountzos E, Kelekis N, Spiliopoulos S. US-guided trocar versus Seldinger technique for percutaneous cholecystostomy (TROSELC II trial). Abdom Radiol (NY) 2023; 48:2425-2433. [PMID: 37081229 DOI: 10.1007/s00261-023-03916-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES The purpose of this study is to investigate the safety and effectiveness of the US-guided bedside trocar vs. the Seldinger technique for percutaneous cholecystostomy (PC) procedures. METHODS This is a prospective single-center, randomized, controlled trial (RCT) comparing the trocar (group T; 50 patients [27 men]; mean [± SD] age, 74.16 ± 15.59 years) with the Seldinger technique for PC (group S; 50 patients [23 men]; mean [± SD] age, 80.78 ± 14.09 years) in consecutive patients undergoing the procedure in a bedside setting with the sole employment of US as a guidance modality. Primary outcomes consisted of technical success and complications associated with the procedure. Secondary outcome measures involved procedure duration, intra-/post-procedure pain evaluation, and clinical success. RESULTS PC was technically successful for all 100 patients. Clinical success rates were similar between group T and S (94% vs. 92%, respectively; p = 0.34). Equal total procedure-related complications were noted in both groups (4% vs. 4%; p = 0.5). A minor bleeding event (bile mixed with blood) occurred in one patient (2%) in group T and one patient (2%) in group S; accidental catheter dislodgement in one patient (2%) from group T, and a small biloma in one patient (2%) from group S. No procedure-related deaths or major bleeding events were noted. PC was significantly faster in group T (1.41 ± 1.13 vs. 4.41 ± 2.68 min; p < 0.001). Mean pain score during PC was significantly lower in group T compared with group S at 12 h of follow-up (1.43 ± 1.45 vs. 3.36 ± 2.05; p < 0.01). CONCLUSION US-guided bedside trocar technique for PC was equally effective and safe as the Seldinger technique, but it was faster and simpler to perform and led to reduced pain following the procedure.
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Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece.
| | - Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Stavros Grigoriadis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Konstantinos Palialexis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
- Interventional Radiology Department, Bioclinic General Hospital of Athens, Marinou Geroulanou 15, 115 24, Athens, Greece
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Efthymia Alexopoulou
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
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Tavassoli A, Zandbaf T, Aslzare M, Rudi IT, Mehri A, Esparham A. A Novel Minimally Invasive technique for dilatation of hepaticojejunostomy stricture: A case report. Clin Case Rep 2023; 11:e7174. [PMID: 37020669 PMCID: PMC10067802 DOI: 10.1002/ccr3.7174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
Using a nephroscope in a laparoscopic operation to relieve the hepaticojejunostomy stricture (HJS) by transjejunal dilatation is a minimally invasive and applicable method. It can be used as the first step for such patients.
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Affiliation(s)
- Alireza Tavassoli
- Endoscopic and Minimally Invasive Surgery Research Center, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Tooraj Zandbaf
- Department of General Surgery, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad UniversityMashhadIran
| | - Mohammad Aslzare
- Department of Urology, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Iman Tavakoli Rudi
- Student Research Committee, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Ali Mehri
- Endoscopic and Minimally Invasive Surgery Research Center, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Ali Esparham
- Student Research Committee, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
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Zhang H, Guo Y, Jiao J, Qiu Y, Miao Y, He Y, Li Z, Xia C, Li L, Cai J, Xu K, Liu X, Zhang C, Bay BH, Song S, Yang Y, Peng M, Wang Y, Fan H. A hepatocyte-targeting nanoparticle for enhanced hepatobiliary magnetic resonance imaging. Nat Biomed Eng 2023; 7:221-235. [PMID: 36536254 DOI: 10.1038/s41551-022-00975-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 10/27/2022] [Indexed: 12/24/2022]
Abstract
Hepatobiliary magnetic resonance imaging (MRI) can inform the diagnosis of liver tumours in patients with liver cirrhosis and hepatitis. However, its clinical utility has been hampered by the lack of sensitive and specific contrast agents, partly because hepatocyte-specific nanoparticles, regardless of their surface ligands, are readily sequestered by Kupffer cells. Here we show, in rabbits, pigs and macaques, that the performance of hepatobiliary MRI can be enhanced by an ultrasmall nanoparticle composed of a manganese ferrite core (3 nm in diameter) and poly(ethylene glycol)-ethoxy-benzyl surface ligands binding to hepatocyte-specific transmembrane metal and anion transporters. The nanoparticle facilitated faster, more sensitive and higher-resolution hepatobiliary MRI than the clinically used contrast agent gadoxetate disodium, a substantial enhancement in the detection rate (92% versus 48%) of early-stage liver tumours in rabbits, and a more accurate assessment of biliary obstruction in macaques. The nanoparticle's performance and biocompatibility support the further translational development of liver-specific MRI contrast agents.
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Affiliation(s)
- Huan Zhang
- Key Laboratory of Synthetic and Natural Functional Molecule of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an, Shaanxi, China
| | - Yingkun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ju Jiao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ying Qiu
- Key Laboratory of Synthetic and Natural Functional Molecule of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an, Shaanxi, China
| | - Yuqing Miao
- Key Laboratory of Synthetic and Natural Functional Molecule of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an, Shaanxi, China
| | - Yuan He
- Key Laboratory of Synthetic and Natural Functional Molecule of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an, Shaanxi, China
| | - Zhenlin Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Li
- State Key Laboratory of Oncology in South China, Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Jing Cai
- State Key Laboratory of Oncology in South China, Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Ke Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoli Liu
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, Xi'an, Shaanxi, China
| | - Ce Zhang
- College of Physics, Northwest University, Xi'an, Shaanxi, China
| | - Boon-Huat Bay
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shijie Song
- Key Laboratory of Standardization and Measurement for Nanotechnology, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yanlian Yang
- Key Laboratory of Standardization and Measurement for Nanotechnology, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Mingli Peng
- Key Laboratory of Synthetic and Natural Functional Molecule of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an, Shaanxi, China
| | - Yaoyu Wang
- Key Laboratory of Synthetic and Natural Functional Molecule of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an, Shaanxi, China
| | - Haiming Fan
- Key Laboratory of Synthetic and Natural Functional Molecule of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an, Shaanxi, China.
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, Xi'an, Shaanxi, China.
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25
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ACG Clinical Guideline: Diagnosis and Management of Biliary Strictures. Am J Gastroenterol 2023; 118:405-426. [PMID: 36863037 DOI: 10.14309/ajg.0000000000002190] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/13/2022] [Indexed: 03/04/2023]
Abstract
A biliary stricture is an abnormal narrowing in the ductal drainage system of the liver that can result in clinically and physiologically relevant obstruction to the flow of bile. The most common and ominous etiology is malignancy, underscoring the importance of a high index of suspicion in the evaluation of this condition. The goals of care in patients with a biliary stricture are confirming or excluding malignancy (diagnosis) and reestablishing flow of bile to the duodenum (drainage); the approach to diagnosis and drainage varies according to anatomic location (extrahepatic vs perihilar). For extrahepatic strictures, endoscopic ultrasound-guided tissue acquisition is highly accurate and has become the diagnostic mainstay. In contrast, the diagnosis of perihilar strictures remains a challenge. Similarly, the drainage of extrahepatic strictures tends to be more straightforward and safer and less controversial than that of perihilar strictures. Recent evidence has provided some clarity in multiple important areas pertaining to biliary strictures, whereas several remaining controversies require additional research. The goal of this guideline is to provide practicing clinicians with the most evidence-based guidance on the approach to patients with extrahepatic and perihilar strictures, focusing on diagnosis and drainage.
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Páez-Carpio A, Hessheimer A, Bermúdez P, Zarco FX, Serrano E, Moreno J, Molina V, Ausania F, Carrero E, Burrel M, Fondevila C, Gómez FM. Percutaneous transhepatic biliary drainage for biliary obstruction in perihilar cholangiocarcinoma: a 10-year analysis of safety and outcomes using the CCI index. Langenbecks Arch Surg 2023; 408:109. [PMID: 36847837 DOI: 10.1007/s00423-023-02852-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/21/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE To evaluate percutaneous transhepatic biliary drainage (PTBD) safety and efficacy in patients with perihilar cholangiocarcinoma (PCCA). METHODS This retrospective observational study included patients with PCCA and obstructive cholestasis referred for a PTBD in our institution between 2010 and 2020. Technical and clinical success rates and major complication and mortality rates one month after PTBD were used as main variables. Patients were divided and analyzed into two groups: > 30 and < 30 Comprehensive Complication Index (CCI). We also evaluated post-surgical outcomes in patients undergoing surgery. RESULTS Out of 223 patients, 57 were included. Technical success rate was 87.7%. Clinical success at 1 week was 83.6%, before surgery 68.2%, 80.0% at 2 weeks and 86.7% at 4 weeks. Mean total bilirubin (TBIL) values were 15.1 mg/dL (baseline), 8.1 mg/dL one week after PTBD), 6.1 mg/dL (2 weeks) and 2.1 mg/dL (4 weeks). Major complication rate was 21.1%. Three patients died (5.3%). Risk factors for major complications after the statistical analysis were: Bismuth classification (p = 0.01), tumor resectability (p = 0.04), PTBD clinical success (p = 0.04), TBIL 2 weeks after PTBD (p = 0.04), a second PTBD (p = 0.01), total PTBDs (p = 0.01) and duration of drainage (p = 0.03). Major postoperative complication rate in patients who underwent surgery was 59.3%, with a median CCI of 26.2. CONCLUSION PTBD is safe and effective in the management of biliary obstruction caused by PCCA. Bismuth classification, locally advanced tumors, and failure to achieve clinical success in the first PTBD are factors related to major complications. Our sample reported a high major postoperative complication rate, although with an acceptable median CCI.
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Affiliation(s)
- Alfredo Páez-Carpio
- Department of Radiology, CDI, Hospital Clínic Barcelona, 08036, Barcelona, Spain.
| | - Amelia Hessheimer
- General and Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, 28046, Madrid, Spain
| | - Patricia Bermúdez
- Department of Radiology, CDI, Hospital Clínic Barcelona, 08036, Barcelona, Spain
| | - Federico X Zarco
- Department of Radiology, CDI, Hospital Clínic Barcelona, 08036, Barcelona, Spain
| | - Elena Serrano
- Department of Radiology, CDI, Hospital Clínic Barcelona, 08036, Barcelona, Spain
| | - Julián Moreno
- Department of Radiology, CDI, Hospital Clínic Barcelona, 08036, Barcelona, Spain
| | - Víctor Molina
- General and Digestive Surgery Service, Hospital de La Santa Creu I Sant Pau, 08035, Barcelona, Spain
| | - Fabio Ausania
- General and Digestive Surgery Service, ICEDM, Hospital Clínic Barcelona, 08036, Barcelona, Spain
| | - Enrique Carrero
- Department of Anesthesiology, Hospital Clínic Barcelona, 08036, Barcelona, Spain
| | - Marta Burrel
- Department of Radiology, CDI, Hospital Clínic Barcelona, 08036, Barcelona, Spain
| | - Constantino Fondevila
- General and Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, 28046, Madrid, Spain
| | - Fernando M Gómez
- Department of Radiology, CDI, Hospital Clínic Barcelona, 08036, Barcelona, Spain
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Pachisia AV, Govil D. Ultrasound-guided Bedside Percutaneous Transhepatic Biliary Drainage in Critically Ill: A Friend Indeed. Indian J Crit Care Med 2023; 27:4-5. [PMID: 36756475 PMCID: PMC9886053 DOI: 10.5005/jp-journals-10071-24393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 01/02/2023] Open
Abstract
How to cite this article: Pachisia AV, Govil D. Ultrasound-guided Bedside Percutaneous Transhepatic Biliary Drainage in Critically Ill: A Friend Indeed. Indian J Crit Care Med 2023;27(1):4-5.
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Affiliation(s)
- Anant Vikram Pachisia
- Institute of Critical Care and Anaesthesiology, Medanta – The Medicity, Gurugram, Haryana, India
| | - Deepak Govil
- Institute of Critical Care and Anaesthesiology, Medanta – The Medicity, Gurugram, Haryana, India
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28
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Dell T, Meyer C. [Biliary system interventions : Percutaneous transhepatic cholangiodrainage to bilioma]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:30-37. [PMID: 36413258 DOI: 10.1007/s00117-022-01083-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND A variety of transhepatic percutaneous biliary procedures are appropriate for the treatment of pathologies of the biliary system. OBJECTIVES The aim of this article is to describe best practices for performing percutaneous transhepatic cholangiography with placement of a biliary drain (PTCD), percutaneous transhepatic removal of bile duct stones, percutaneous stenting of the bile ducts, and percutaneous treatment of postoperative bilioma. MATERIALS AND METHODS The authors reviewed existing literature on relevant current recommendations and presented them based on their own facility's approach. RESULTS Biliary interventions are mostly aimed at treating some form of cholestasis of benign or malignant etiology. The technical success rate is up to 90%. CONCLUSION Percutaneous biliary interventions are safe and effective procedures in the treatment of pathologies of the biliary system, preferably used when endoscopic access is not possible due to anatomical conditions.
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Affiliation(s)
- Tatjana Dell
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Carsten Meyer
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
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Vrachliotis TG, Spiliopoulos S, Voros D. Management of massive bilothorax post-percutaneous trans-hepatic biliary drainage. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022; 53:59. [DOI: 10.1186/s43055-022-00733-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 02/21/2022] [Indexed: 02/08/2023] Open
Abstract
Abstract
Background
Iatrogenic bilothorax is an infrequent major complication of percutaneous trans-hepatic biliary drainage (PTBD) and optimal treatment remains under-reported. The authors herein describe a case of PTBD complicated by a massive bilous effusion.
Case presentation
An 80-year-old male underwent PTBD due to malignant obstructive jaundice (total bilirubin 20.0 mg/dL). Following discharge, the patient was readmitted with severe dyspnea and recurrence of jaundice (total bilirubin 15.0 mg/dL). CT depicted the drainage catheter traversing the right costophrenic sulcus, complete obliteration of the right pleural space, no aerated right lung parenchyma and left mediastinal shift. The pleural effusion was successfully drained, and the biliary drainage catheter tract was sealed with Gelfoam pledgets and coils, to prevent bilopleural fistula formation and recurrence of the effusion.
Conclusions
In this case, a successful totally percutaneous management of iatrogenic bilothorax following PTBD is described. Due to the potential of rapid clinical deterioration and empyema formation, immediate evaluation and treatment are warranted. Prompt pleural drainage with antibiotic therapy and bile flow diversion from the pleural cavity are required.
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30
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Lubbe J, Lindemann J, Gondo W, Kolev N, Aclavio P, Hofmeyr S, Jonas E. Endoscopic versus percutaneous intervention for palliation in malignant hilar bile duct obstruction - A comparative cohort study. HPB (Oxford) 2022; 24:2145-2156. [PMID: 36253268 DOI: 10.1016/j.hpb.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/09/2022] [Accepted: 09/14/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Biliary drainage in patients managed palliatively for malignant hilar obstruction can be achieved by endoscopic transpapillary stenting using endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic stent or catheter placement using percutaneous transhepatic cholangiography (PTC). This study compares ERC and PTC drainage for malignant hilar bile duct obstruction. METHODS A retrospective study of drainage procedures at two academic hospitals was conducted from 2015 to 2020. Procedural success (divided into access-, bridging-, and technical success), therapeutic success, duration of therapeutic success and complications were analysed for different Bismuth-Corlette stricture types. RESULTS A total of 293 patients were included, 153 (52.2%) in the ERC group and 140 (47.8%) in the PTC group. Access and bridging success in the ERC and PTC groups were 83.5% vs. 97.2% (p < 0.001) and 90.2% vs. 84.5% (p = 0.119), respectively. Technical and therapeutic success were equivalent between the two groups (98.3% vs. 99.3%, p = 0.854 and 81.7% vs. 73.3%, p = 0.242). Duration of therapeutic success was longer after ERC drainage compared to PTC drainage (p = 0.009) with a 3-month gain in duration of therapeutic success after ERC drainage (p = 0.006, 95% CI [26-160]). Cholangitis rates were equivalent (21.4% vs. 24.7%, p = 0.530), pancreatitis was more common in the ERC group (9.4% vs. 0%, p < 0.001) and procedure-related deaths more common in the PTC group (6.0% vs. 15.8%, p < 0.001). CONCLUSION Although ERC and PTC drainage of malignant hilar obstruction were similar regarding technical and therapeutic success, ERC drainage was more durable. Outcome differences for B-C stricture types should be explored in future studies.
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Affiliation(s)
- Jeanne Lubbe
- University of Stellenbosch, Department of Surgical Sciences, Division of Surgery, Tygerberg Hospital, Parow, South Africa; Department of Clinical Sciences, Intervention and Technology (CLINTEC), Centre for Digestive Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | - Jessica Lindemann
- Department of Surgery, University of Cape Town Faculty of Health Sciences, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa; Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Washington Gondo
- University of Stellenbosch, Department of Surgical Sciences, Division of Surgery, Tygerberg Hospital, Parow, South Africa
| | - Nina Kolev
- Department of Surgery, University of Cape Town Faculty of Health Sciences, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Peter Aclavio
- Department of Surgery, University of Cape Town Faculty of Health Sciences, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Stefan Hofmeyr
- University of Stellenbosch, Department of Surgical Sciences, Division of Surgery, Tygerberg Hospital, Parow, South Africa
| | - Eduard Jonas
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Centre for Digestive Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Surgery, University of Cape Town Faculty of Health Sciences, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
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Park SE, Nam IC, Baek HJ, Ryu KH, Lim SG, Won JH, Kim DR. Effectiveness of ultrasound-guided percutaneous transhepatic biliary drainage to reduce radiation exposure: A single-center experience. PLoS One 2022; 17:e0277272. [PMID: 36331963 PMCID: PMC9635691 DOI: 10.1371/journal.pone.0277272] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Percutaneous transhepatic biliary drainage (PTBD) has been an effective treatment to access the biliary tree, especially in case of endoscopically inaccessible biliary tree. In general, PTBD techniques are divided into two methods: fluoroscopy-guided PTBD and ultrasound (US)-guided PTBD. This study aimed to evaluate the effectiveness of US-guided PTBD, focusing on radiation exposure according to intrahepatic duct (IHD) dilatation degree, differences between right- and left-sided approaches and differences between benign and malignant biliary stenosis/obstruction. We evaluated technical success, clinical success, procedural data (the number of liver capsule punctures, procedural time, fluoroscopy time and radiation dose), and procedure-related complications. During the study period, a total of 123 patients with biliary stenosis/obstruction or bile leakage were initially eligible. We excluded 76 patients treated with only ERCP or initially treated with ERCP followed underwent PTBD insertion. Finally, a total of 50 procedures were performed in 47 patients. Of the 47 patients, 8 patients had anatomical alteration due to previous surgery, 6 patients refused ERCP, and 3 patients failed ERCP. For the remaining 30 patients, PTBD was performed on weekend or at night, 11 of whom had poor general condition, 10 patients underwent ERCP 3 to 4 days later after PTBD insertion, 6 patients improved after PTBD insertion without ERCP, 1 patient died, and 1 patient was referred to other hospital. Remaining 1 patient underwent surgery due to Mirizzi syndrome. All procedures were performed by two interventional radiologists. Technical success rate was 100%, clinical success was 94%, and the complication rate was 10%. Fluoroscopy time and the reported radiation dose were significantly lower in patients with dilated bile ducts than in those with non-dilated bile ducts, when biliary puncture under US guidance was performed initially. However, even in patients with non-dilated bile ducts undergoing initial trials of biliary puncture under US guidance, the fluoroscopy time and the reported radiation dose were low, based on current studies. No statistical significant differences were observed in terms of technical and dosimetry results according to right-sided and left-sided procedures and benign and malignant biliary stenosis/obstruction. Thus, US-guided PTBD was found to be a safe and effective technique that significantly reduced fluoroscopy time and radiation doses.
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Affiliation(s)
- Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Seongsan-gu, Changwon, Korea
| | - In Chul Nam
- Department of Radiology, Jeju National University School of Medicine, Jeju Natuional University Hospital, Jeju, Korea
- * E-mail:
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Seongsan-gu, Changwon, Korea
| | - Kyeong Hwa Ryu
- Department of Radiology, Samsung Changwon Hospital, Changwon, Korea
| | - Sung Gong Lim
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Seongsan-gu, Changwon, Korea
| | - Jung Ho Won
- Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Doo Ri Kim
- Department of Radiology, Jeju National University School of Medicine, Jeju Natuional University Hospital, Jeju, Korea
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Widyaningtiyas I, Sarastika HY, Utama HW. Bleeding after percutaneous transhepatic biliary drainage due to arterial injury: A case study in patient with stable hemodynamic. Radiol Case Rep 2022; 17:4868-4873. [PMID: 36263331 PMCID: PMC9574574 DOI: 10.1016/j.radcr.2022.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/13/2022] [Accepted: 09/17/2022] [Indexed: 11/06/2022] Open
Abstract
Percutaneous transhepatic biliary drainage (PTBD) is an effective procedure for correcting biliary obstructions. It can be performed under ultrasound and fluoroscopic equipment; however, it may entail serious complications, including bleeding, caused by arterial or venous injury. We present a 49-year-old man presented with a 1-month history of icterus, jaundice, dark urine, and right hypochondrial pain. MR imaging discovered a dilatation of the right intrahepatic bile duct due to obstruction by intrahepatic cholangiocarcinoma. PTBD procedure was performed in the right intrahepatic bile duct. After the pigtail drain device was inserted, the bile fluid color that came out from the pigtail turned sanguineous; nonetheless, the patient's hemodynamic was stable. Therefore, the second cholangiography was performed for evaluation. Some resistance was sensed during contrast injection into the bile duct, and the operator pushed the contrast media a little bit stronger and found a filling defect formed by a clot in the bile duct that suggested high suspicion of vessel injury. Although the patient's hemodynamics was still stable, the operator quickly decided to perform a hepatic arteriography procedure because bright red blood through the tube and a relatively rapid clot formed from the puncture point and distal drain, which were signs of hepatic artery injury. Hepatic arteriography confirmed the location of pseudoaneurysm caused by vessel trauma and arterio-intrahepatic bile duct fistulation. The embolization procedure was performed using PVA-300 into a ruptured hepatic artery branch through a microcatheter. Re-evaluation arteriography showed no pseudoaneurysm or arterio-intrahepatic bile duct fistulation after embolization.
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Handke NA, Ollig A, Attenberger UI, Luetkens JA, Faron A, Pieper CC, Schmeel FC, Kupczyk PA, Meyer C, Kuetting D. Percutaneous transhepatic biliary drainage: a retrospective single-center study of 372 patients. Acta Radiol 2022; 64:1322-1330. [PMID: 36128748 DOI: 10.1177/02841851221127809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Complication rates in percutaneous transhepatic biliary drainage (PTBD) are non-uniform and vary considerably. In addition, the impact of peri-procedural risk factors is under-investigated. PURPOSE To compare success and complication rates of PTBD in patients with and without accompanying technical risk factors. MATERIAL AND METHODS A single-center retrospective study was conducted from January 2004 to December 2016. Patients receiving PTBD due to biliary obstruction or biliary leakage were included. Technical risk factors (non-distended bile ducts, ascites, obesity, anasarca, non-compliance) were assessed. Complications were classified according to the Society of Interventional Radiology. RESULTS In total, 372 patients were included (57.3% men, 42.7% women; mean age = 66 years). Overall, 466 PTBDs were performed. Of the patients, 70.1% presented with malignancy and biliary obstruction; 26.8% had benign biliary obstruction; 3.1% had biliary leakage. Technical risk factors were reported in 57 (15.3%) patients. Overall technical success of initial PTBD was 98.7%, primary technical success was 97.9%. In patients with non-dilatated bile ducts, primary technical success was 68.2%. Overall complication rate was 15.0% (8.1% major complications, 6.9% minor complications). Neither major nor minor complications were more frequent in patients with technical risk factors (P > 0.05). In left-sided PTBD, hemorrhage was more frequent (P = 0.015). Patients with malignancy were significantly more affected by drainage-related complications (P = 0.004; odds ratio = 2.03). The mortality rate was 0.5% (n = 2). CONCLUSION PTBD is a safe and effective method for the treatment of biliary obstruction and biliary leaks. Complication rates are low, even in procedures with risk factors.
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Affiliation(s)
- Nikolaus A Handke
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | - Annika Ollig
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | | | - Julian A Luetkens
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | - Anton Faron
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | - Claus C Pieper
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | | | - Patrick A Kupczyk
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | - Carsten Meyer
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | - Daniel Kuetting
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
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Li H, Ge N, He C, Wang X, Xu W, Huang J, Yang Y. Portal vein embolization in the treatment of portal vein bleeding after percutaneous transhepatic biliary drainage: A case report and literature review. J Interv Med 2022; 5:217-220. [DOI: 10.1016/j.jimed.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/26/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022] Open
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Khurana N, Salei A, Gunn AJ, Huang J. Antibiotics Tubes and Lines. Semin Intervent Radiol 2022; 39:421-427. [PMID: 36406021 PMCID: PMC9671683 DOI: 10.1055/s-0042-1758080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Antibiotic prophylaxis in interventional radiology (IR) is widely used; however, such practice is based on data from the surgical literature. Although published guidelines can help determine the need for prophylactic antibiotic use in the patient undergoing percutaneous procedures, local practice patterns often dictate when such medications are given. In this article, the current state of periprocedural antibiotic use in commonly performed IR procedures (i.e., tube and catheter placements) is presented.
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Affiliation(s)
- Navpreet Khurana
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aliaksei Salei
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew J. Gunn
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Junjian Huang
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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Effect of Preserving the Percutaneous Gallbladder Drainage Tube Before Laparoscopic Cholecystectomy on Surgical Outcome: Post Hoc Analysis of the CSGO-HBP-017. J Gastrointest Surg 2022; 26:1224-1232. [PMID: 35314945 DOI: 10.1007/s11605-022-05291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/26/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND When percutaneous transhepatic gallbladder drainage (PTGBD) is followed by laparoscopic cholecystectomy (LC), there is no consensus regarding whether the drainage tube should be preserved or removed before LC. We hypothesized that the surgical results of LC might differ between cases with PTGBD tube preservation versus removal. Here, we investigated how drainage tube preservation or removal affected the surgical outcome of LC. METHODS Using data from our previous multicenter study, we compared LC outcomes after PTGBD between patients with PTGBD tube preservation versus removal. This study included 208 patients who underwent LC over 12 days after PTGBD. In 83 cases, the PTGBD tube was preserved until LC, and in 125 cases, the tube was removed before LC. The results were verified by propensity score matching with 50 patients in each group. RESULTS Cases with tube preservation versus removal exhibited significantly longer surgery duration (174 ± 105 min vs 145 ± 61 min, P = .0118) and postoperative hospital stay (14 ± 16 days vs 7 ± 7 days, P < .0001), a significantly higher postoperative complication rate (13.2% vs 3.2%, P = .0061), and a marginally higher incidence of open conversion (12.0% vs 4.8%, P = .0547). Propensity score matching verified the inferior surgical outcomes in cases with tube preservation. CONCLUSIONS These results imply that when LC is performed > 12 days after PTGBD, the surgical outcome may be inferior when the drainage tube is preserved rather than removed before LC.
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Usefulness of ultrasound-guided core biopsy in thyroid nodules with inconclusive fine-needle aspiration biopsy findings. RADIOLOGIA 2022; 64:195-205. [PMID: 35676051 DOI: 10.1016/j.rxeng.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/04/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine the diagnostic performance of ultrasound-guided core-needle biopsy in thyroid nodules after two inconclusive fine-needle aspiration biopsies. To assess the complications of core-needle biopsy. To analyze the reliability of diagnoses obtained with core-needle biopsy. To measure the economic impact of avoiding lobectomies in patients with benign core-needle biopsy findings. MATERIAL AND METHODS This retrospective study reviewed 195 core-needle biopsies in 178 patients. To determine the reliability of the core-needle biopsy findings, we compared the diagnosis from the core-needle specimen versus the histologic findings in the surgical specimens when core-needle biopsy findings indicated malignancy or follicular proliferation and versus the stability of the nodule on ultrasound follow-up for one year when core-biopsy findings indicated benignity. RESULTS Core-needle biopsy yielded a diagnosis for 179 (91.7%) nodules, of which 122 (62.5%) were classified as benign, 50 (25.6%) as follicular proliferation, and 7 (3.6%) as malignant. The findings were inconclusive for 16 (8.3%) nodules. Minor complications were observed in 4 (2%) patients; no major complications were observed. The sensitivity of core-needle biopsy for the diagnosis of thyroid cancer was low (42.8%) because the technique was unable to detect capsular or vascular invasion, although the specificity and positive predictive value (PPV) were 100%. However, when we considered histologic findings of malignancy and follicular proliferation positive because both require surgical resection, the sensitivity increased to 97.5% and the PPV decreased to 83.3%. There were 79 nodules with ultrasound follow-up for at least one year; 76 (96.2%) had negative core-needle biopsy findings, and 74 (97.3%) of these remained stable. The negative predictive value (NPV) for malignancy of the benign nodules was 98.6%, although no malignant transformation was observed. Nevertheless, the results of the statistical analysis do not allow us to recommend forgoing ultrasound follow-up in patients with benign core-biopsy findings. The cost savings of avoiding lobectomy in patients with benign nodules and stability of the nodule on ultrasound follow-up for at least one year was about 90%. CONCLUSIONS Core-needle biopsy of thyroid nodules is effective because it diagnoses more than 90% of nodules with inconclusive findings after fine-needle aspiration biopsy. It is safe if done by experienced professionals. It is reliable because it yields 100% specificity and 100% PPV for malignant nodule, 97.5% sensitivity for the detection of nodules that require surgery, and 98.6% NPV for benign nodules. It is efficient because it reduces the costs of diagnosis compared to lobectomy in benign nodules.
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Onishi Y, Shimizu H, Ohno T, Furuta A, Isoda H, Okamoto T, Okajima H, Nakamoto Y. Percutaneous Transhepatic Biliary Intervention in Adult Biliary Atresia Patients After Kasai Portoenterostomy. JPGN REPORTS 2022; 3:e206. [PMID: 37168905 PMCID: PMC10158411 DOI: 10.1097/pg9.0000000000000206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/11/2022] [Indexed: 05/13/2023]
Abstract
Kasai portoenterostomy (KP) is a standard treatment for patients with biliary atresia (BA). After KP, patients with BA occasionally develop biliary complications, such as recurrent cholangitis, biliary stricture, and cystic dilatation of the intrahepatic bile duct. Percutaneous transhepatic biliary drainage is one of the treatment options for these biliary complications. However, limited information is available on percutaneous transhepatic biliary drainage performed after KP in adult BA patients with native livers. Herein, we describe 8 cases of percutaneous transhepatic biliary interventions performed after KP in 7 adult BA patients with native livers. Cholangiography showed multiple cystic dilatation of the intrahepatic bile ducts. Advancing a guidewire and catheter was difficult due to the multiple dilatations and strictures of the bile duct. Successful biliary drainage tube placement and clinical improvement was achieved in 5 and 3 cases, respectively. Because of its technical difficulty and limited clinical effectiveness, it is not recommended that it be performed easily.
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Affiliation(s)
- Yasuyuki Onishi
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hironori Shimizu
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsuyoshi Ohno
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiro Furuta
- Department of Radiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Hiroyoshi Isoda
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Okamoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideaki Okajima
- Department of Pediatric Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Yuji Nakamoto
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Ding Z, Chen J, Chen Z, Zeng X, Zheng P, Wang X, Cui X, Sang L. Efficacy and Safety of Thermal Ablation for Treating Lymph Node Metastasis From Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:738299. [PMID: 35433407 PMCID: PMC9010561 DOI: 10.3389/fonc.2022.738299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/08/2022] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate the efficacy and safety of thermal ablation, including radiofrequency ablation (RFA), microwave ablation (MVA), and laser ablation (LA), for treating lymph node metastasis (LNM) from papillary thyroid carcinoma (PTC). Design and Methods PubMed and EMBASE were searched for studies reporting the efficacy and safety of thermal ablation for treating LNM in PTC. After selecting the relevant literature (including 11 papers, 208 patients, 412 lymph nodes), the QUADAS-2 tool was used to evaluate its quality. Then, both the fixed-effects and random-effects models combined with subgroup analysis were used to calculate data on volume changes in metastatic lymph nodes and changes in serum thyroglobulin (Tg) levels. We pooled the proportion of major and overall complication rates and complete disappearance rates and used subgroup forest plots and funnel plots for visual representation. Because of publication bias, we also performed a trim-and-filled model for correction. The rate of recurrence and distant metastasis with ablated details were pooled. Results In the 11 articles (208 patients and 412 diseased lymph nodes), all thermal ablation methods showed effectiveness in reducing lymph node volume (P = 0.02) and serum Tg levels (P < 0.01) which showed no between-group difference. The pooled proportion of major complications was 0%(95% CI: -0.14; 0.15, P = 1) and the overall complication rate was 5% (95% CI: -0.09; 0.20, P = 1), which revealed no significant difference among modalities. The pooled proportion of the complete disappearance rate was 82% (95% CI: 0.43; 0.96, P < 0.01) and the data with statistical significance which contains RFA and LA showed complete disappearance rate was 59% and 81% respectively. Conclusion All thermal ablation methods, including RFA, MWA, and LA, were effective and safe for treating LNM in PTC and were especially suitable for nonsurgical patients. Besides, subgroup analysis showed no significant difference, except for LA is better than RFA in complete disappearance rate.
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Affiliation(s)
- Zheng Ding
- The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Juan Chen
- The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhiguang Chen
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Xiaoke Zeng
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Pengchao Zheng
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Xuemei Wang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Xinwu Cui
- Departmant of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xinwu Cui, ; Liang Sang,
| | - Liang Sang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
- *Correspondence: Xinwu Cui, ; Liang Sang,
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Risk Factors For Bleeding Adverse Events In Percutaneous Transhepatic Biliary Drainage: A Prospective Multicenter Study (BleeCom Study). J Vasc Interv Radiol 2022; 33:919-925.e2. [DOI: 10.1016/j.jvir.2022.04.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/29/2022] [Accepted: 04/21/2022] [Indexed: 11/23/2022] Open
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Critically-Ill Patients with Biliary Obstruction and Cholangitis: Bedside Fluoroscopic-Free Endoscopic Drainage versus Percutaneous Drainage. J Clin Med 2022; 11:jcm11071869. [PMID: 35407477 PMCID: PMC8999535 DOI: 10.3390/jcm11071869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 01/27/2023] Open
Abstract
Severe acute cholangitis is a life-threatening medical emergency. Endoscopic biliary drainage (EBD) or percutaneous transhepatic biliary drainage (PTBD) is usually used for biliary decompression. However, it can be risky to transport a critical patient to the radiology unit. We aimed to compare clinical outcomes between bedside, radiation-free EBD and fluoroscopic-guided PTBD in patients under critical care. METHODS A retrospective study was conducted on critically ill patients admitted to the intensive care unit with biliary obstruction and cholangitis from January 2011 to April 2020. RESULTS A total of 16 patients receiving EBD and 31 patients receiving PTBD due to severe acute cholangitis were analyzed. In the EBD group, biliary drainage was successfully conducted in 15 (93.8%) patients. Only one patient (6.25%) encountered post-procedure pancreatitis. The 30-day mortality rate was no difference between the 2 groups (32.72% vs. 31.25%, p = 0.96). Based on multivariate analysis, independent prognostic factors for the 30-day mortality were a medical history of malignancy other than pancreatobiliary origin (HR: 5.27, 95% confidence interval [CI]: 1.01-27.57) and emergent dialysis (HR: 7.30, 95% CI: 2.20-24.24). CONCLUSIONS Bedside EBD is safe and as effective as percutaneous drainage in critically ill patients. It provides lower risks in patient transportation but does require experienced endoscopists to perform the procedure.
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Jeon TY, Choi MH, Yoon SB, Soh JS, Moon SH. Systematic review and meta-analysis of percutaneous transluminal forceps biopsy for diagnosing malignant biliary strictures. Eur Radiol 2022; 32:1747-1756. [PMID: 34537877 DOI: 10.1007/s00330-021-08301-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/11/2021] [Accepted: 08/23/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To perform a systematic review and meta-analysis to determine the diagnostic performance of percutaneous transluminal forceps biopsy (PTFB) for differentiating malignant from benign biliary stricture. METHODS A comprehensive literature search of the PubMed, EMBASE, and Ovid MEDLINE databases was conducted to identify original articles published between January 2001 and January 2021 reporting the diagnostic accuracy of PTFB. A random-effects model was used to summarize the diagnostic odds ratio and other measures of accuracy. RESULTS Fourteen studies involving 1762 patients met the inclusion criteria and were included in the meta-analysis. The meta-analysis summary estimates of PTFB for diagnosis of malignant biliary strictures were as follows: sensitivity 81% (95% confidence interval [CI], 78-81%); specificity 100% (95% CI, 98-100%); diagnostic odds ratio 85.34 (95% CI, 38.37-189.81). The area under the curve of PTFB was 0.948 in the diagnosis of malignant biliary strictures. The diagnostic sensitivity was higher in intrinsic (85%) than in extrinsic (73%) biliary strictures. The pooled rate of all complications was 10.3% (95% CI, 7.0-14.2%), including a major complication rate of 3.1%. CONCLUSION These data demonstrate that PTFB is sensitive and highly specific for diagnosing malignancy in biliary strictures. PTFB should be incorporated into future guidelines for tissue sampling in biliary cancer, especially in cases with failed endoscopic management. KEY POINTS • PTFB had a good overall diagnostic performance for differentiating malignant from benign biliary strictures, with a meta-analysis summary estimate of 81% for sensitivity and 100% for specificity. • PTFB had higher sensitivity for cholangiocarcinoma (85%) than for other cancers (73%). • PTFB had a 100% technical success rate and a 10.3% rate for complications, including a 3.1% rate for major complications.
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Affiliation(s)
- Tae Yeon Jeon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Moon Hyung Choi
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seung Bae Yoon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea.
| | - Jae Seung Soh
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea
| | - Sung-Hoon Moon
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea.
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Abstract
If endoscopic retrograde cholangiopancreatography (ERCP) fails in cases of biliary obstruction and jaundice, percutaneous drains have been traditionally the current second-line option. Endoscopic ultrasonography-guided biliary drainage (EUS-BD) with choledocoduodenostomy or hepaticogastrostomy is alternative modality that have shown equivalent or better technical and clinical success compared with percutaneous drainage. Similarly, EUS-guided gallbladder drainage has emerged as a therapeutic option in acute cholecystitis as well. Furthermore, EUS-BD avoids some of the pitfalls of percutaneous drainage. Current research in EUS-BD involves optimizing devices to improve technical and clinical success. In centers with advanced endoscopists trained in these procedures, EUS-BD is an excellent second-line modality.
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Affiliation(s)
- Shyam Vedantam
- Department of Medicine, University of Miami, Miami, FL, USA
| | - Sunil Amin
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami, 1120 NW 14th Street, Clinical Research Building, Suite 11145 (D-49), Miami, FL 33136, USA.
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Complications of percutaneous transhepatic cholangiography and biliary drainage, a multicenter observational study. Abdom Radiol (NY) 2022; 47:3338-3344. [PMID: 34357434 PMCID: PMC9388415 DOI: 10.1007/s00261-021-03207-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/05/2021] [Accepted: 07/01/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Over 2500 percutaneous transhepatic cholangiography and biliary drainage (PTCD) procedures are yearly performed in the Netherlands. Most interventions are performed for treatment of biliary obstruction following unsuccessful endoscopic biliary cannulation. Our aim was to evaluate complication rates and risk factors for complications in PTCD patients after failed ERCP. METHODS We performed an observational study collecting data from a cohort that was subjected to PTCD during a 5-year period in one academic and four teaching hospitals. Primary objective was the development of infectious (sepsis, cholangitis, abscess, or cholecystitis) and non-infectious complications (bile leakage, severe hemorrhage, etc.) and mortality within 30 days of the procedure. Subsequently, risk factors for complications and mortality were analyzed with a multilevel logistic regression analysis. RESULTS A total of 331 patients underwent PTCD of whom 205 (61.9%) developed PTCD-related complications. Of the 224 patients without a pre-existent infection, 91 (40.6%) developed infectious complications, i.e., cholangitis in 26.3%, sepsis in 24.6%, abscess formation in 2.7%, and cholecystitis in 1.3%. Non-infectious complications developed in 114 of 331 patients (34.4%). 30-day mortality was 17.2% (N = 57). Risk factors for infectious complications included internal drainage and drain obstruction, while multiple re-interventions were a risk factor for non-infectious complications. CONCLUSION Both infectious and non-infectious complications are frequent after PTCD, most often due to biliary drain obstruction.
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Shin MH, Choi NK. Feasibility of surgeon-performed percutaneous transhepatic gallbladder drainages in patients with acute cholecystitis. Ann Surg Treat Res 2022; 102:257-262. [PMID: 35611088 PMCID: PMC9111964 DOI: 10.4174/astr.2022.102.5.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/25/2022] [Accepted: 03/10/2022] [Indexed: 12/07/2022] Open
Abstract
Purpose This study aimed to evaluate the feasibility of surgeon-performed percutaneous transhepatic gallbladder drainage (PTGBD). Methods Patients treated with PTGBD for acute cholecystitis (AC), performed by surgeons at Chosun University Hospital for 12 months between March 2017 and February 2018, were enrolled retrospectively, into the S-PTGBD group (n = 134). Patients with PTGBD performed by interventional radiologists for 12 months, 6 months before March 2017, and after February 2018, were included in the X-PTGBD group (n = 107). In addition to the basic characteristics of the patients, severity of AC, comorbidities, intervals from hospital admission to the PTGBDs, procedural times, technical success rates, intention-to-treat rates, and complication rates were evaluated and compared. Results Except for the patient’s age (older in S-PTGBD), there were no differences in the patient’s basic profiles, including the severity of the AC and comorbidities. Although the procedural times were significantly shorter in the X-PTGBD group (18.13 minutes vs. 11.39 minutes), effectiveness indicators such as the technical success rates and intention-to-treat rates and safety, such as the major complication rates in the S-PTGBD group, were comparable with those in the X-PTGBD group. The intervals between hospital admissions and PTGBDs were shorter in the S-PTGBD group, although this difference disappeared in the high-risk group. Effectiveness and safety in the high-risk group were also comparable between the groups. Conclusion The PTGBDs performed by surgeons are as effective and safe as those performed by interventional radiologists with faster implementation of PTGBD.
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Affiliation(s)
- Min-Ho Shin
- Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Department of Surgery, Chosun University Hospital, Gwangju, Korea
| | - Nam-Kyu Choi
- Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Department of Surgery, Chosun University Hospital, Gwangju, Korea
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46
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Percutaneous cholecystostomy: An update for the 2020s. North Clin Istanb 2021; 8:537-542. [PMID: 34909596 PMCID: PMC8630714 DOI: 10.14744/nci.2021.81594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/02/2021] [Indexed: 12/24/2022] Open
Abstract
Cholecystectomy is the standard treatment of acute cholecystitis. Surgery, however, poses significant risks for patients with advanced age and/or comorbid conditions. For such patients, percutaneous cholecystostomy (PC) is the only option. This interventional procedure does not have any absolute contraindications because of the life-threatening nature of the disease, in which other treatment options cannot be offered due to their risks. Nonetheless, these risk factors necessitate performing PC under urgent, rapid, and in many cases suboptimal conditions. In this article, PC was revisited in the light of our extensive experience in addition to the most current literature. Pre-procedural evaluation including the risk assessment and procedural steps was presented in detail. If conducted properly, PC provides significant clinical improvement in the short term and is life-saving, especially in the elderly and in patients with comorbid diseases or high surgical risk. It may also be the definitive treatment method for acute cholecystitis.
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47
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Karagyozov PI, Tishkov I, Boeva I, Draganov K. Endoscopic ultrasound-guided biliary drainage-current status and future perspectives. World J Gastrointest Endosc 2021; 13:607-618. [PMID: 35070022 PMCID: PMC8716984 DOI: 10.4253/wjge.v13.i12.607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/17/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction. ERCP could fail in cases of duodenal obstruction, duodenal diverticulum, ampullary neoplastic infiltration or surgically altered anatomy. In these cases percutaneous biliary drainage (PTBD) is traditionally used as a rescue procedure but is related to high morbidity and mortality and lower quality of life. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a relatively new interventional procedure that arose due to the development of curvilinear echoendoscope and the various endoscopic devices. A large amount of data is already collected that proves its efficacy, safety and ability to replace PTBD in cases of ERCP failure. It is also possible that EUS-BD could be chosen as a first-line treatment option in some clinical scenarios in the near future. Several EUS-BD techniques are developed EUS-guided transmural stenting, antegrade stenting and rendezvous technique and can be personalized depending on the individual anatomy. EUS-BD is normally performed in the same session from the same endoscopist in case of ERCP failure. The lack of training, absence of enough dedicated devices and lack of standardization still makes EUS-BD a difficult and not very popular procedure, which is related to life-threatening adverse events. Developing training models, dedicated devices and guidelines hopefully will make EUS-BD easier, safer and well accepted in the future. This paper focuses on the technical aspects of the different EUS-BD procedures, available literature data, advantages, negative aspects and the future perspectives of these modalities.
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Affiliation(s)
- Petko Ivanov Karagyozov
- Department of Interventional Gastroenterology, Clinic of Gastroenterology, Acibadem City Clinic Tokuda Hopsital, Sofia 1407, Bulgaria
| | - Ivan Tishkov
- Department of Interventional Gastroenterology, Clinic of Gastroenterology, Acibadem City Clinic Tokuda Hopsital, Sofia 1407, Bulgaria
| | - Irina Boeva
- Department of Interventional Gastroenterology, Clinic of Gastroenterology, Acibadem City Clinic Tokuda Hopsital, Sofia 1407, Bulgaria
| | - Kiril Draganov
- Clinic of Liver, Biliary, Pancreatic and General Surgery, Acibadem City Clinic Tokuda Hospital, Sofia 1407, Bulgaria
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Lee YT, Yen KC, Liang PC, Wu CH. Procedure-related risk factors for bleeding after percutaneous transhepatic biliary drainage: A systematic review and meta-analysis. J Formos Med Assoc 2021; 121:1680-1688. [PMID: 34903432 DOI: 10.1016/j.jfma.2021.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/30/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/PURPOSE Bleeding is the most dreaded complication after percutaneous transhepatic biliary drainage (PTBD). Clarifying the risk factors of bleeding can reduce the morbidity and mortality rates of PTBD. However, the procedure-related risk factors for bleeding after PTBD are still controversial. Therefore, this systematic review and meta-analysis were performed to identify procedure-related risk factors of bleeding after PTBD. METHODS PubMed, Cochrane database, and Google Scholar were searched for published studies until 1st May 2021. Inclusion criteria were: studies associated with bleeding complications after PTBD and with sufficient data to compare different procedure-related factors for bleeding. Sources of bias were assessed using the Newcastle-Ottawa Scale and Cochrane risk-of-bias tool for randomised trials. Probable procedure-related risk factors were evaluated and outcomes were expressed in the case of dichotomous variables, as an odds ratio (OR) (with a 95% confidence interval, (CI)). RESULTS Eleven studies were included in the meta-analysis. There was no significant difference in bleeding rates with respect to the side of PTBD (left/right, OR = 1.10, 95% CI: 0.68-1.76), the insertion level of bile duct (central/peripheral, OR = 1.39, 95% CI: 0.82-2.35), and the usage of ultrasound guidance (OR: 1.25, 95% CI: 0.60-2.60). A subgroup analysis revealed a left-sided approach that resulted in more hepatic arterial injuries than the right-sided approach (left/right, OR = 1.93, 95% CI: 1.32-2.83). CONCLUSION Left-sided approach is a risk factor for hepatic arterial injuries after PTBD.
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Affiliation(s)
- Yao-Ting Lee
- Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuang-Chen Yen
- Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Chin Liang
- Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Medical Imaging, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chih-Horng Wu
- Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Filipović AN, Mašulović D, Zakošek M, Filipović T, Galun D. Total Fluoroscopy Time Reduction During Ultrasound- and Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage Procedure: Importance of Adjusting the Puncture Angle. Med Sci Monit 2021; 27:e933889. [PMID: 34802031 PMCID: PMC8614062 DOI: 10.12659/msm.933889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/30/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this observational cohort study was to assess patient and operator-dependent factors which could have an impact on total fluoroscopy time during ultrasound and fluoroscopy-guided percutaneous transhepatic biliary drainage (PTBD). MATERIAL AND METHODS Between October 2016 and November 2020, 127 patients with malignant biliary obstruction underwent ultrasound- and fluoroscopy-guided PTBD with the right-sided intercostal approach. The initial bile duct puncture was ultrasound-guided in all patients, and the puncture angle was measured by ultrasound. Any subsequent steps of the procedure were performed under continuous fluoroscopy (15 fps). The patients were divided in 2 groups based on the puncture angle: ≤30° (group I) and >30° (group II). In a retrospective analysis, both groups were compared for inter- and intragroup variability, technical success, total fluoroscopy time, and complications. RESULTS In group II, the recorded total fluoroscopy time (232.20±140.94 s) was significantly longer than that in group I (83.44±52.61 s) (P<0.001). In both groups, total fluoroscopy time was significantly longer in cases with a lesser degree of bile duct dilatation, intrahepatic bile duct tortuosity, presence of liver metastases, and multiple intrahepatic bile duct strictures. CONCLUSIONS The initial bile duct puncture angle was identified as an operator-dependent factor with the possible impact on total fluoroscopy time. The puncture angle of less than 30° was positively correlated with overall procedure efficacy and total fluoroscopy time reduction.
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Affiliation(s)
- Aleksandar N. Filipović
- Center for Radiology and Magnetic Resonance Imaging (MRI), University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Mašulović
- Center for Radiology and Magnetic Resonance Imaging (MRI), University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miloš Zakošek
- Center for Radiology and Magnetic Resonance Imaging (MRI), University Clinical Centre of Serbia, Belgrade, Serbia
| | - Tamara Filipović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute for Rehabilitation, Belgrade, Serbia
| | - Danijel Galun
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- HPB Unit, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
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Survival benefit of percutaneous transhepatic biliary drainage for malignant biliary tract obstruction-a prospective study comparing external and internal drainage techniques. Abdom Radiol (NY) 2021; 46:5408-5416. [PMID: 34292362 DOI: 10.1007/s00261-021-03215-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the clinical results of percutaneous transhepatic biliary drainage (PTBD) in patients with non-operable malignant biliary tract obstruction (MBTO) and the survival benefit of internal drainage. METHODS Prospective data of consecutive patients of PTBD from May 2014 to August 2017 was analyzed for 30-day, 90-day and 1-year mortality, and mean survival of patients undergoing external drainage (ED) and internal drainage (ID) using internal-external ring biliary catheterization or biliary stent were compared. Other important variables evaluated were drop in the total bilirubin (TBil) levels, improvement in pain and pruritus, procedure-related complications, and patient satisfaction. RESULTS In 87 cases (54 male, 33 female) with mean age 37.3 y (22-70 y; 95% CI: 31.1 y-43.5 y), 10, 45 and 32 patients underwent stenting, external and internal-external catheterization, respectively (total 152 procedures [> 1 in 35.63%, n = 31]). PTBD resulted in decrease in mean TBil by 8.2738 ± 0.912 mg/dL at 30 days (P < 0.001), 55.14% (n = 48) cases reaching 3 mg/dL at mean 45 days, and 35/48 cases received chemotherapy. Overall mortality was 6.89%, 37.93% and 90.80% at 30 days, 90 days and 1 year, respectively. Mean survival with ID (236.40 ± 33.37 days) was better than with ED (110.35 ± 26.16 days) (P < 0.001). Pain (62.06%; n = 54; mean Visual Analog Scale [VAS] score = 6.7) improved significantly (mean VAS score 3.4; P < 0.001). Pruritus (n = 29) was relieved in 100% of the cases. Complication rate of 18.39% (n = 16) and no procedure-related death were seen. CONCLUSION PTBD offers a safe and significant improvement in TBil, pain, and pruritus in non-operable MBTO, with ID offering additional survival benefit over ED.
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