Role of Interventional Radiology in the Management of Acute Cholangitis

2021 ◽  
Vol 38 (03) ◽  
pp. 321-329
Author(s):  
Pouya Entezari ◽  
Jonathan A. Aguiar ◽  
Riad Salem ◽  
Ahsun Riaz
Keyword(s):  
Interventional Radiology ◽  
Biliary Drainage ◽  
Multiorgan Failure ◽  
Acute Cholangitis ◽  
Review Article ◽  
Endoscopic Drainage ◽  
Local Infection ◽  
General Management ◽  
Fatal Sepsis

AbstractAcute cholangitis presents with a wide severity spectrum and can rapidly deteriorate from local infection to multiorgan failure and fatal sepsis. The pathophysiology, diagnosis, and general management principles will be discussed in this review article. The focus of this article will be on the role of biliary drainage performed by interventional radiology to manage acute cholangitis. There are specific scenarios where percutaneous drainage should be preferred over endoscopic drainage. Percutaneous transhepatic and transjejunal biliary drainage are both options available to interventional radiology. Additionally, interventional radiology is now able to manage these patients beyond providing acute biliary drainage including cholangioplasty, stenting, and percutaneous cholangioscopy/biopsy.

scholarly journals Sphincterotomy with endoscopic biliary drainage for severe acute cholangitis: a meta-analysis

2017 ◽  
Vol 05 (02) ◽  
pp. E103-E109 ◽  
Author(s):  
Tarek Sawas ◽  
Noura Arwani ◽  
Shadi Al Halabi ◽  
John Vargo
Keyword(s):  
Success Rate ◽  
Biliary Drainage ◽  
Meta Analysis ◽  
Acute Cholangitis ◽  
Endoscopic Drainage ◽  
Endoscopic Biliary Drainage ◽  
Significant Difference ◽  
Obstructive Cholangitis ◽  
Effective Drainage

Abstract Aims To investigate the role of endoscopic sphincterotomy (ES) with endoscopic biliary drainage (EBD) in acute severe obstructive cholangitis management by performing a meta-analysis of controlled trials. Method We searched PubMed and Embase for controlled studies that compared endoscopic drainage with ES versus Non-ES in acute obstructive cholangitis. Two reviewers selected the studies and extracted the data. Disagreement was addressed by a third reviewer. Heterogeneity of the studies was analyzed by Cochran’s Q statistics. A Mantel–Haenszel risk ratio was calculated utilizing a random effects model. Results Four controlled studies met our inclusion criteria with 392 participants (201 ES, 191 Non-ES). The outcomes were drainage insertion success rate, drainage effectiveness, post drainage pancreatitis, bleeding, procedure duration, perforation, cholecystitis, and 30-day mortality. Drainage insertion success rate was identical in both groups (RR: 1.00, 95 %CI% 0.96 – 1.04). Effective drainage was not significantly different (RR: 1.11, 95 %CI 0.73 – 1.7). There was no significant difference in the incidence of pancreatitis post EBD between the ES and Non-ES groups at 3 % and 4 %, respectively (RR: 0.73, 95 %CI 0.24 – 2.27). However, there was a significant increase in post EBD bleeding with ES compared to Non-ES (RR: 8.58, 95 %CI 2.03 – 36.34). Thirty-day mortality was similar between ES and Non-ES groups at 0.7 % and 1 %, respectively (RR: 0.5, 95 %CI 0.05 – 5.28). Conclusion Our findings show that EBD without ES is an effective drainage technique and carries less risk for post procedure bleeding. Patients who are critically ill and have coagulopathy should be spared from undergoing ES in the acute phase.

scholarly journals Emergent Treatment of Acute Cholangitis and Acute Cholecystitis

2020 ◽  
Vol 37 (01) ◽  
pp. 014-023
Author(s):  
Rakesh Navuluri ◽  
Matthew Hoyer ◽  
Murat Osman ◽  
Jonathan Fergus
Keyword(s):  
Interventional Radiology ◽  
Acute Cholecystitis ◽  
Biliary Tract ◽  
Medical Management ◽  
Treatment Options ◽  
Acute Cholangitis ◽  
Signs And Symptoms ◽  
Biliary Sepsis

AbstractAcute pathology of the biliary tract including cholangitis and cholecystitis can lead to biliary sepsis if early decompression is not performed. This article provides an overview of the presenting signs and symptoms and role of interventional radiology in the management of patients with acute cholangitis or acute cholecystitis. It is especially important to understand the role of IR in the context of other treatment options including medical management, endoscopy, and surgery.

scholarly journals Melatonin as a Potential Adjuvant Treatment for COVID-19 beyond Sleep Disorders

2021 ◽  
Vol 22 (16) ◽  
pp. 8623
Author(s):  
Adam Wichniak ◽  
Aleksander Kania ◽  
Mariusz Siemiński ◽  
Wiesław Jerzy Cubała
Keyword(s):  
Sleep Disturbances ◽  
Randomized Clinical Trials ◽  
Therapeutic Option ◽  
Multiorgan Failure ◽  
Review Article ◽  
Respiratory Drive ◽  
Sleep Wake Disorders ◽  
Recommended Treatment ◽  
Ventilator Induced Lung Injury

Melatonin is registered to treat circadian rhythm sleep–wake disorders and insomnia in patients aged 55 years and over. The essential role of the circadian sleep rhythm in the deterioration of sleep quality during COVID-19 confinement and the lack of an adverse effect of melatonin on respiratory drive indicate that melatonin has the potential to be a recommended treatment for sleep disturbances related to COVID-19. This review article describes the effects of melatonin additional to its sleep-related effects, which make this drug an attractive therapeutic option for treating patients with COVID-19. The preclinical data suggest that melatonin may inhibit COVID-19 progression. It may lower the risk of the entrance of the SARS-CoV-2 virus into cells, reduce uncontrolled hyper-inflammation and the activation of immune cells, limit the damage of tissues and multiorgan failure due to the action of free radicals, and reduce ventilator-induced lung injury and the risk of disability resulting from fibrotic changes within the lungs. Melatonin may also increase the efficacy of COVID-19 vaccination. The high safety profile of melatonin and its potential anti-SARS-CoV-2 effects make this molecule a preferable drug for treating sleep disturbances in COVID-19 patients. However, randomized clinical trials are needed to verify the clinical usefulness of melatonin in the treatment of COVID-19.

Gallbladder: Role of Interventional Radiology

2021 ◽  
Vol 38 (03) ◽  
pp. 330-339
Author(s):  
Matthew Antalek ◽  
Ahsun Riaz ◽  
Albert A. Nemcek
Keyword(s):  
Interventional Radiology ◽  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Biliary Drainage ◽  
Potential Role ◽  
Percutaneous Cholecystostomy ◽  
Biliary Strictures ◽  
Biliary Pathology ◽  
Technical Considerations

AbstractPercutaneous cholecystostomy is an established procedure for the management of patients with acute cholecystitis and with significant medical comorbidities that would make laparoscopic cholecystectomy excessively risky. In this review, we will explore the role of percutaneous cholecystostomy in the management of acute cholecystitis as well as other applications in the management of biliary pathology. The indications, grading, technical considerations, and postprocedure management in the setting of acute cholecystitis are discussed. In addition, we will discuss the potential role of percutaneous cholecystostomy in the management of gallstones and biliary strictures, in establishing internal biliary drainage, and in a joint setting with other clinicians such as gastroenterologists in the management of complex biliary pathology.

Role of USG guidance in percutaneous needle puncture in interventional radiology

2020 ◽  
Vol 14 (2) ◽  
pp. 49-53
Author(s):  
Sharad B Ghatge ◽  
◽  
Shivraj M Ingole ◽  
Keyword(s):  
Interventional Radiology ◽  
Needle Puncture

Population Control (Review Article)

1961 ◽  
Vol 1 (3) ◽  
pp. 89-98
Author(s):  
Karol J. Krotki
Keyword(s):  
Population Control ◽  
Review Article ◽  
Small Enterprise ◽  
Opportunity Costs ◽  
Relative Importance ◽  
Factual Information ◽  
Undue Influence ◽  
Clear Cut ◽  
Economic Considerations

Discussions about the role of small enterprise in economic development tend to remain inconclusive partly because of the difficulty of assessing the relative importance of economic and non-economic objectives and partly because of the dearth of factual information on which to base an economic calculus. It is probably true, moreover, that, because of a lack of general agreement as to the economic case for or against small enterprise, non-economic considerations, including some merely romantic attitudes toward smallness and bigness, tend to exert an undue influence on public policies. There may, of course, be no clear-cut economic case. And noneconomic considerations should and will inevitably weigh significantly in policy decisions. If, however, some of the economic questions could be settled by more and better knowledge, these decisions could more accurately reflect the opportunity costs of pursuing non-economic objectives.

Bioengineered in vitro Vascular Models for Applications in Interventional Radiology

2019 ◽  
Vol 24 (45) ◽  
pp. 5367-5374 ◽  
Author(s):  
Xiaoyun Li ◽  
Seyed M. Moosavi-Basri ◽  
Rahul Sheth ◽  
Xiaoying Wang ◽  
Yu S. Zhang
Keyword(s):  
Interventional Radiology ◽  
Animal Models ◽  
Blood Vessels ◽  
In Vitro Models ◽  
The Past ◽  
Endovascular Interventions ◽  
Conventional Animal ◽  
Vascular Structures

The role of endovascular interventions has progressed rapidly over the past several decades. While animal models have long-served as the mainstay for the advancement of this field, the use of in vitro models has become increasingly widely adopted with recent advances in engineering technologies. Here, we review the strategies, mainly including bioprinting and microfabrication, which allow for fabrication of biomimetic vascular models that will potentially serve to supplement the conventional animal models for convenient investigations of endovascular interventions. Besides normal blood vessels, those in diseased states, such as thrombosis, may also be modeled by integrating cues that simulate the microenvironment of vascular disorders. These novel engineering strategies for the development of biomimetic in vitro vascular structures will possibly enable unconventional means of studying complex endovascular intervention problems that are otherwise hard to address using existing models.

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