Interventional Radiology–Operated Cholecystoscopy for the Management of Symptomatic Cholelithiasis: Approach, Technical Success, Safety, and Clinical Outcomes

Background Small bowel bleeding (SBB) accounts for 5%–10% of all cases of acute gastrointestinal bleeding. Transcatheter arterial embolization (TAE) plays an important role in the treatment of SBB. Purpose To evaluate the safety and efficacy of superselective TAE exclusively for SBB and to assess factors associated with clinical outcomes. Material and Methods From January 2006 to April 2017, 919 patients were admitted with signs and symptoms of gastrointestinal bleeding; 74 patients (mean age = 57.5 years; age range = 14–82 years) with positive angiographic findings for SBB were retrospectively analyzed. The technical success of TAE and clinical outcomes, including recurrent bleeding, major complications, and in-hospital mortality were evaluated. The associations of various clinical and technical factors with clinical outcomes were analyzed. Results The bleeding foci were in the ileum in 48 (65%) patients and the jejunum in 26 (35%). Technical success was achieved in 72 (97%) patients. The rates of recurrent bleeding, major complications, and in-hospital mortality were 12% (7/57), 21% (15/71), and 25% (18/72), respectively. Superselective embolization was a significant prognostic factor associated with fewer major complications (OR = 0.069; P = 0.003). The increased number of embolized vasa recta was significantly associated with a higher probability of major complications (OR = 2.64; P < 0.001). The use of N-butyl cyanoacrylate was associated with lower rates of major complication (OR = 0.257; P = 0.027). Conclusion TAE is a safe and effective treatment modality for SBB. In addition, whenever possible, TAE should be performed in a superselective manner to minimize ischemic complications.

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Percutaneous closure of patent foramen ovale: technical success and clinical outcomes of an infrequently-performed procedure

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2008.02.015 ◽

2008 ◽

Vol 9 (2) ◽

pp. 105

Author(s):

F Aslam

Keyword(s):

Clinical Outcomes ◽

Patent Foramen Ovale ◽

Percutaneous Closure ◽

Foramen Ovale ◽

Technical Success

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Single-center experience with a dual microcatheter technique for the endovascular treatment of wide-necked aneurysms

Journal of Neurosurgery ◽

10.3171/2014.7.jns132237 ◽

2014 ◽

Vol 121 (5) ◽

pp. 1093-1101 ◽

Cited By ~ 9

Author(s):

Christopher R. Durst ◽

Robert M. Starke ◽

John R. Gaughen ◽

Scott Geraghty ◽

K. Derek Kreitel ◽

...

Keyword(s):

Endovascular Treatment ◽

Clinical Outcomes ◽

Technical Success ◽

Parent Vessel ◽

Technical Success Rate ◽

Single Center Experience ◽

Long Term Follow Up ◽

Coil Migration

Object The endovascular treatment of wide-necked aneurysms can be technically challenging due to distal coil migration or impingement of the parent vessel. In this paper, the authors illustrate an alternative method for the treatment of wide-necked intracranial aneurysms using a dual microcatheter technique. Methods The authors' first 100 consecutive patients who underwent coil embolization of a wide-necked aneurysm using a dual microcatheter technique are reported. With this technique, 2 microcatheters are used to introduce coils into the aneurysm. The coils are deployed either sequentially or concurrently to form a stable construct and prevent coil herniation or migration. Angiographic and clinical outcomes are reported. Results The technical success rate of the dual microcatheter technique is 91% with a morbidity and mortality of 1% and 2%, respectively. Clinical outcomes are excellent with 93% of patients demonstrating a modified Rankin Scale score of 0–2 at long-term follow-up regardless of their score at presentation. Retreatment rates are 18%. Conclusions The dual microcatheter technique may be a safe and efficacious first line of treatment for widenecked aneurysms.

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Comparison of Fully-Covered vs Partially Covered Self-Expanding Metallic Stents for Palliative Treatment of Inoperable Esophageal Malignancy: A Systematic Review and Meta-Analysis

10.21203/rs.2.16864/v1 ◽

2019 ◽

Author(s):

Chunmei Wang ◽

Hua Wei ◽

Yuxia Li

Keyword(s):

Esophageal Cancer ◽

Clinical Outcomes ◽

Palliative Treatment ◽

Meta Analysis ◽

Stent Migration ◽

Metallic Stents ◽

Cochrane Central Register ◽

Technical Success ◽

Significant Difference ◽

Esophageal Malignancy

Abstract Purpose: This study aimed to compare clinical outcomes following placement of fully covered self-expanding metallic stents (FCSEMS) vs partially covered self-expanding metallic stents (PCSEMS) for palliative treatment of inoperable esophageal cancer. Materials and Methods: We searched PubMed, ScienceDirect, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases from inception up to 10 th July 2019. Studies comparing clinical outcomes with FCSEMS vs PCSEMS in patients with inoperable esophageal cancer requiring palliative treatment for dysphagia were included. Results: Five studies were included in the review. 299 patients received FCSEMS while 313 patients received PCSEMS in the five studies. Improvement in dysphagia was reported with both FCSEMS and PCSEMS in the included studies. Meta-analysis indicated no significant difference in technical success between the two groups (Odds ratio [OR] 1.32, 95%CI 0.30-5.03, P= 0.78; I 2 =12%). There was no difference in the rates of stent migration between FCSEMS and PCSEMS (OR 1.32, 95%CI 0.30-5.03, P= 0.78; I 2 =12%). Similarly, there was no difference between the two stents for obstruction due to tissue growth (OR 0.86, 95%CI 0.51-1.44, P= 0.56; I 2 =7%) or by food (OR 0.33, 95%CI 0.10-1.06, P= 0.06; I 2 =23%). Incidence of bleeding (OR 0.57, 95%CI 0.21-1.58, P= 0.28; I 2 =0%) and chest pain (OR 1.06, 95%CI 0.44-2.57, P= 0.89; I 2 =0%) was similar in the two groups. Sub-group analysis of RCTs and non-RCTs produced similar results. The overallrall quality of studies was not high. Conclusion: Our results indicate that there is no difference in technical success, stent migration, and stent obstruction, with FCSEMS or PCSEMS when used for palliative treatment of esophageal malignancy. Further RCTs are required to provide stronger evidence on this topic.

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Clinical outcomes of EUS-guided drainage of debris-containing pancreatic pseudocysts: a large multicenter study

Endoscopy International Open ◽

10.1055/s-0042-121666 ◽

2017 ◽

Vol 05 (02) ◽

pp. E130-E136 ◽

Cited By ~ 2

Author(s):

Dennis Yang ◽

Sunil Amin ◽

Susana Gonzalez ◽

Daniel Mullady ◽

Steven Edmundowicz ◽

...

Keyword(s):

Treatment Outcomes ◽

Clinical Outcomes ◽

The United States ◽

Term Treatment ◽

Pancreatic Pseudocysts ◽

Endoscopic Drainage ◽

Technical Success ◽

Long Term Treatment

Abstract Background and study aims Data on clinical outcomes of endoscopic drainage of debris-free pseudocysts (PDF) versus pseudocysts containing solid debris (PSD) are very limited. The aims of this study were to compare treatment outcomes between patients with PDF vs. PSD undergoing endoscopic ultrasound (EUS)-guided drainage via transmural stents. Patients and methods Retrospective review of 142 consecutive patients with pseudocysts who underwent EUS-guided transmural drainage (TM) from 2008 to 2014 at 15 academic centers in the United States. Main outcome measures included TM technical success, treatment outcomes (symptomatic and radiologic resolution), need for endoscopic re-intervention at follow-up, and adverse events (AEs). Results TM was performed in 90 patients with PDF and 52 with PSD. Technical success: PDF 87 (96.7 %) vs. PSD 51 (98.1 %). There was no difference in the rates for endoscopic re-intervention (5.5 % in PDF vs. 11.5 % in PSD; P = 0.33) or AEs (12.2 % in PDF vs. 19.2 % in PSD; P = 0.33). Median long-term follow-up after stent removal was 297 days (interquartile range [IQR]: 59 – 424 days) for PDF and 326 days (IQR: 180 – 448 days) for PSD (P = 0.88). There was a higher rate of short-term radiologic resolution of PDF (45; 66.2 %) vs. PSD (21; 51.2 %) (OR = 0.30; 95 % CI: 0.13 – 0.72; P = 0.009). There was no difference in long-term symptomatic resolution (PDF: 70.4 % vs. PSD: 66.7 %; P = 0.72) or radiologic resolution (PDF: 68.9 % vs. PSD: 78.6 %; P = 0.72) Conclusions There was no difference in need for endoscopic re-intervention, AEs or long-term treatment outcomes in patients with PDF vs. PSD undergoing EUS-guided drainage with transmural stents. Based on these results, the presence of solid debris in pancreatic fluid collections does not appear to be associated with a poorer outcome.

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Water-Soluble Contrast Challenge for Suspected Small Bowel Obstruction: Technical Success Rate, Accuracy, and Clinical Outcomes

American Journal of Roentgenology ◽

10.2214/ajr.21.26132 ◽

2021 ◽

Author(s):

Edward M. Lawrence ◽

Perry J. Pickhardt

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Success Rate ◽

Clinical Outcomes ◽

Bowel Obstruction ◽

Water Soluble ◽

Technical Success ◽

Technical Success Rate ◽

Water Soluble Contrast

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Simultaneous Rapid Saline Flush to Correct Catheter Malposition: A Clinical Overview

Journal of the Association for Vascular Access ◽

10.1016/j.java.2015.03.002 ◽

2015 ◽

Vol 20 (3) ◽

pp. 159-166 ◽

Cited By ~ 5

Author(s):

Elizabeth Natividad ◽

Todd Rowe

Keyword(s):

Interventional Radiology ◽

Clinical Outcomes ◽

Vascular Access ◽

Vena Cava ◽

Cost Savings ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Quality Outcomes ◽

Catheter Malposition ◽

And Migration

Abstract Central venous catheters and peripherally inserted central catheters are fundamental in the delivery of pharmacologic and nutrition therapies to patient populations, including individuals with cancer. Malposition and migration of these catheters outside of the superior or inferior vena cava can contribute to delays in therapy as individuals await repositioning, and in some cases replacement of the catheter. Traditional repositioning using overwire or interventional radiology techniques can be costly and may delay care. The placement and management of these catheters has increasingly become the domain of specially trained vascular access nurses. A team of specially trained vascular access nurses, in collaboration with interventional radiologists at a National Cancer Institute-designated comprehensive cancer center developed a procedure for catheter repositioning using a simultaneous rapid saline flush technique (SRSFT). We present this procedure, along with implications for cost and clinical outcomes. Clinical outcomes suggest that 68% of catheters have been successfully repositioned using this technique with no adverse events associated with the procedure noted to date. In addition, the use of the SRSFT represents a cost savings of up to 90% compared with traditional repositioning procedures. The SRSFT is identified as safe, timely, cost-conscious, and therapeutically effective, although further research is needed to formally evaluate the efficacy of repositioning using this technique compared with overwire and interventional-radiology-guided repositioning, including complications and quality outcomes.

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