Transarterial embolisation for gastroduodenal bleeding following endoscopic resection

2021 ◽  
pp. 20210062
Author(s):  
Suyoung Park ◽  
Boryeong Jeong ◽  
Ji Hoon Shin ◽  
Eun Ho Jang ◽  
Jung Han Hwang ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Clinical Success ◽  
Vital Signs ◽  
Left Gastric Artery ◽  
Gelatin Sponge ◽  
Success Rates ◽  
Gastric Artery ◽  
Delayed Bleeding ◽  
Transcatheter Arterial Embolisation ◽  
Angiographic Findings

Objectives: Transcatheter arterial embolisation (TAE) is widely used to treat gastrointestinal bleeding. This paper reports the safety and efficacy of TAE for bleeding following endoscopic resection, including endoscopic mucosal resection and endoscopic submucosal dissection. Methods: Fifteen consecutive patients (13 males, two females; mean age 62.2 years) from two tertiary medical centres who underwent TAE for gastroduodenal bleeding after endoscopic resection from November 2001 to December 2020 were included. Patient demographics, clinical presentations, angiographic findings, and TAE details were retrospectively reviewed. Results: Immediate bleeding during endoscopic resection was noted in four patients. Delayed bleeding 1–30 days after endoscopic resection in nine patients presented with haematochezia (n = 4), haematemesis (n = 6) and melaena (n = 1). Endoscopic haemostasis was attempted in 11 patients (73.3%) but failed due to continued bleeding despite haemostasis (n = 6), failure to secure endoscopic field (n = 3) and unstable vital signs (n = 2). Eleven patients had positive angiographic findings for bleeding, and all bleeding arteries were embolised except one owing to failed superselection of the bleeder. In the other four patients with negative angiographic findings, the left gastric artery with/without the right gastric artery or the accessory left gastric artery was empirically embolised using gelatin sponge particles. Both technical and clinical success rates were 93.3% (14/15). No procedure-related complications occurred during follow-up. Conclusions: TAE is safe and effective in the treatment of immediate and delayed bleeding after endoscopic resection procedures. Advances in knowledge: This is the first and largest 20-year bicentric study published in English on this topic. Empirical TAE for angiographically negative bleeding sites was also effective without significant complications.

Analysis of the origin of the right inferior phrenic artery in 178 patients with hepatocellular carcinoma treated by chemoembolization via the right inferior phrenic artery

2007 ◽  
Vol 48 (7) ◽  
pp. 728-733 ◽  
Author(s):  
S. Kimura ◽  
M. Okazaki ◽  
H. Higashihara ◽  
Y. Nozaki ◽  
M. Haruno ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Left Gastric Artery ◽  
Celiac Artery ◽  
Gastric Artery ◽  
Inferior Phrenic Artery ◽  
Pancreatic Artery ◽  
Phrenic Artery ◽  
The Right ◽  
Angiographic Findings ◽  
Arterial Chemoembolization

Background: No previous report has described the level of the origin of the right inferior phrenic artery (RIPA) based on an analysis of the relationships between the level of the RIPA, the celiac artery (CA), the superior mesenteric artery (SMA), and the right renal artery (RRA) in a series of cases. Purpose: To evaluate the origin of the RIPA by retrospectively analyzing angiographic findings in 178 patients with hepatocellular carcinoma (HCC) who underwent transcatheter arterial chemoembolization (TACE) via the RIPA. Material and Methods: In patients treated with intraarterial chemoembolization for HCC, additional superselective chemoembolization of the RIPA branches was necessary in 178 cases. We analyzed the level of the origin of the RIPA in these patients according to the relationships between the level of the origin of the RIPA, the CA, the SMA, and the RRA on angiography. Results: Among the 178 cases, the RIPA arose from 1) the aorta directly in 102 cases (57%), 2) the CA in 53 (30%), 3) the left gastric artery (LGA) in three (2%), 4) the dorsal pancreatic artery (DPA) in one (1%), and 5) the RRA in 19 (11%). The level of the origin of the RIPA that originated directly from the aorta was supraceliac in 56 cases (32%), between the CA and the SMA in 31 (17%), and between the SMA and the RRA in 15 (8%). Conclusion: In our study, the RIPA originated from the aorta between the CA and the SMA directly in 17% of cases. When it is difficult to identify the origin of the RIPA, we must keep in mind that the RIPA may originate from the right part of the aorta within the small distance between the SMA and the CA.

Plug-Assisted Retrograde Transvenous Obliteration

2017 ◽  
Vol 01 (04) ◽  
pp. 293-301
Author(s):  
Eung Kim ◽  
Dong Gwon
Keyword(s):  
Hepatic Encephalopathy ◽  
Clinical Success ◽  
Treatment Options ◽  
Clinical Effectiveness ◽  
Gastric Varices ◽  
Gelatin Sponge ◽  
Success Rates ◽  
Endoscopic Injection ◽  
Balloon Catheters ◽  
Portosystemic Shunts

AbstractGastric fundal varices and portosystemic hepatic encephalopathy are major complications of portal hypertension in patients with liver cirrhosis. Many treatment options have been used for gastric varices, including endoscopic injection and transjugular intrahepatic portosystemic shunts (TIPS), but the clinical effectiveness of these treatments remains contentious. Today, balloon-occluded retrograde transvenous obliteration (BRTO) has become the treatment of choice because of its excellent clinical effectiveness and outcomes; however, the associated use of sclerosants and temporary indwelling balloon catheters can cause specific complications. Vascular plugs are another option that has been shown to be safe, feasible, and effective when used as an embolic material in vascular disease. Recently, a technique has been developed that uses such vascular plugs with a gelatin sponge to embolize gastrorenal shunts. This technique is known as plug-assisted retrograde transvenous obliteration (PARTO), and it is also associated with high technical and clinical success rates. Moreover, it appears to be a much safer and more feasible procedure than BRTO. In this review, we introduce PARTO and outline its strengths and potential for use as the treatment of choice in gastric varices and hepatic encephalopathy.

Transcatheter Chemoembolization of a Hepatocellular Carcinoma Utilizing Lipiodol through the Pancreaticoduodenal Arcade: A Case Report

2018 ◽  
Vol 2 ◽  
pp. 5
Author(s):  
Scott P Patterson ◽  
Richard G Foster
Keyword(s):  
Hepatocellular Carcinoma ◽  
Case Report ◽  
Vascular Anatomy ◽  
Left Gastric Artery ◽  
Target Lesion ◽  
Celiac Artery ◽  
Small Hepatocellular Carcinoma ◽  
Gastric Artery ◽  
Variant Anatomy ◽  
Pancreaticoduodenal Arcade

This case report describes the chemoembolization of a small hepatocellular carcinoma employing a lipiodol drug delivery system utilizing a novel arterial pathway. Because the target lesion was precariously located adjacent to the inferior heart border and the diaphragm, it was unsuitable for imaging-guided microwave ablation. To achieve chemoembolization, several intraprocedural adaptations were necessary, given the variant anatomy encountered and difficulty accessing the left gastric artery through a celiac artery approach. The left gastric artery was selected from a superior mesenteric artery approach through the pancreaticoduodenal arcade (Rio Branco’s arcade). This case illustrates the importance of a mastery of the vascular anatomy and variants of hepatic arterial flow.

scholarly journals Comparison of different techniques for the management of venous steno-occlusive lesions during placement of peripherally inserted central catheter

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Woo Jin Yang ◽  
Danbee Kang ◽  
Ji Hoon Shin ◽  
Eun Ho Jang ◽  
Seung Yeon Noh ◽  
...  
Keyword(s):  
Clinical Success ◽  
Alternative Pathway ◽  
Transluminal Angioplasty ◽  
Second Line ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Success Rates ◽  
Initial Attempt ◽  
Technical Success Rate ◽  
Occlusive Lesion

AbstractThe purpose of this study is to investigate strategies for peripherally inserted central catheter (PICC) placement in patients with venous steno-occlusive lesion (VSOL). We performed a retrospective cohort study in adults with central or peripheral VSOL who underwent PICC placement procedures from January 2015 to December 2018. Four different strategies [selecting alternative pathway/over the wire (SAP/OTW), percutaneous transluminal angioplasty (PTA), re-puncture in ipsilateral arm (RIA), and catheter placement in the contralateral arm (CICA)] were analyzed and we compared the clinical outcomes by strategy and compared the strategy between central and peripheral VSOLs. During 4 years, 258 PICC procedures performed in patients with VSOLs, 100 PICC were included in the analysis. The overall technical success rate of initial attempt with SAP/OTW was 32.2%. As a second-line technique, PTA was most frequently used in both central (100%) and peripheral (68.2%) VSOL groups. The clinical success rates within 2 months of SAP/OTW, PTA, RIA, CICA were 55.2%, 43.2%, 14.3%, and 33.3%, respectively (P = 0.24). In conclusion, when the SAP/OTW failed, the PTA can be preferred as a second-line technique for both central and peripheral VSOLs. When guidewire passage fails, the operator could adopt the RIA or CICA technique as an alternative method.

scholarly journals Surgical outcome of percutaneous transhepatic gallbladder drainage in acute cholecystitis: Ten years’ experience at a tertiary care centre

2021 ◽  
Author(s):  
Szabolcs Ábrahám ◽  
Illés Tóth ◽  
Ria Benkő ◽  
Mária Matuz ◽  
Gabriella Kovács ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Acute Cholecystitis ◽  
Conversion Rate ◽  
Clinical Success ◽  
Definitive Treatment ◽  
Success Rates ◽  
Female Ratio ◽  
Gallbladder Drainage ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Grade Iii

Abstract Background Percutaneous transhepatic gallbladder drainage (PTGBD) plays an important role in the treatment of elderly patients and/or patients in poor health with acute cholecystitis (AC). The primary aim of this study is to determine how these factors influence the clinical outcome of PTGBD. Moreover, we assessed the timing and results of subsequent cholecystectomies. Patients and Methods We retrospectively examined the results of 162 patients undergoing PTGBD between 2010 and 2020 (male–female ratio: 51.23% vs. 48.77%; mean age: 71.43 ± 13.22 years). Patient’s performance status and intervention outcomes were assessed with clinical success rates (CSR) and in-hospital mortality. The conversion rate (CR) of possible urgent or delayed, elective laparoscopic cholecystectomies (LC) after PTGBD were analysed. Results PTGBD was the definitive treatment in 42.18% of patients, while it was a bridging therapy prior to cholecystectomy (CCY) for the other patients. CSR was 87.97%, it was only 64.29% in grade III AC. In 9.87% of the cases, urgent LC was necessary after PTGBD, and its conversion rate was approximately equal to that of elective LC (18.18 vs. 17.46%, respectively, p = 0.2217). Overall, the post-PTGBD in-hospital mortality was 11.72%, while the same figure was 0% for grade I AC, 7.41% for grade II and 40.91% for grade III. Based on logistic regression analyses, in-hospital mortality (OR 6.07; CI 1.79–20.56), clinical progression (OR 7.62; CI 2.64–22.05) and the need for emergency CCY (OR 14.75; CI 3.07–70.81) were mostly determined by AC severity grade. Conclusion PTGBD is an easy-to-perform intervention with promising clinical success rates in the treatment of acute cholecystitis. After PTGBD, the level of gallbladder inflammation played a decisive role in the course of AC. In a severe, grade III inflammation, we have to consider low CSR and high mortality.

scholarly journals Management of anticoagulants in delayed bleeding after endoscopic resection: A systematic review and meta-analysis

2021 ◽  
Vol 09 (07) ◽  
pp. E1128-E1135
Author(s):  
Xianhong Zhao ◽  
Yangxue Huang ◽  
Jiarong Li ◽  
Aoqiang Zhou ◽  
Gengxin Chen ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Clinical Effect ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Delayed Bleeding ◽  
Best Management ◽  
Significant Difference ◽  
Meta Analyses ◽  
Bridge Therapy

Abstract Background and study aims Delayed bleeding and thrombotic events are uncontrolled adverse events that are hard to balance in patients receiving anticoagulants after endoscopic resection. The present study aims to assess the clinical effect of warfarin, when compared to direct oral anticoagulants (DOACs), in terms of delayed bleeding and thrombotic events. Methods A comprehensive electronic literature search was conducted for eligible literature. Pairwise meta-analyses were performed on outcomes of delayed bleeding and thrombotic events. Two networks within the Bayesian framework were established based on the management of anticoagulants and type of DOAC. Results Eight cohort studies with 2,046 patients were eligible for inclusion, including 1,176 patients treated with warfarin and 870 with DOACs. There was no significant difference between warfarin and DOACs, in terms of delayed bleeding (OR = 1.29, 95 % CI [0.99–1.69]) and thromboembolism (OR = 2.0, 95 % CI [0.32–12.39]). In the network meta-analyses for delayed bleeding, the rank probabilities revealed that the safest management was discontinuous warfarin without heparin bridge therapy (HBT). Rank probabilities for the types of DOACs demonstrated that the safest drug was dabigatran. Conclusions There was no significant difference in delayed bleeding and thromboembolism between warfarin and DOACs in patients receiving endoscopic treatment. In terms of delayed bleeding, discontinuous warfarin without HBT was suggested as the best management, and dabigatran was recommended as the best type of DOAC.

scholarly journals Prognostic impact of lymph node metastasis along the left gastric artery in esophageal squamous cell carcinoma

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xuan Liu ◽  
Leilei Wu ◽  
Dongkun Zhang ◽  
Peng Lin ◽  
Hao Long ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Cox Regression ◽  
Left Gastric Artery ◽  
Prognostic Impact ◽  
Gastric Artery ◽  
Term Survival

Abstract Background Although the incidence of lymph node (LN) metastasis (LNM) along the left gastric artery is high, its relationship with the prognosis in postoperative patients with esophageal squamous cell carcinoma (ESCC) is rarely reported. This study clarified the prognostic impact of LNM along the left gastric artery in postoperative patients with ESCC. Methods This study assessed data of 1521 patients with ESCC who underwent esophagectomy at the Sun Yat-sen University Cancer Center between March 1992 and March 2012. A chi-squared test and Mann-Whitney U test were used to explore the preliminary correlation between clinical factors and LNM along the left gastric artery. Univariate and multivariate Cox regression analyses were used to assess whether LNM along the left gastric artery was an independent predictor of overall survival. Kaplan–Meier analysis and the log-rank test were used to present a classifying effect based on LN status. Results LNM was observed in 598 patients (39.3%) and was found along the branches of the left gastric artery in 256 patients (16.8%). The patients were classified into two groups based on the presence of LNM along the left gastric artery. Patients without LNM along the left gastric artery had better cancer-specific survival than those with positive LNs (P <  0.001). Conclusions This study indicated that LNM along the left gastric artery was an important independent prognostic factor for long-term survival among ESCC patients (P = 0.011).

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