Challenging delayed bleeding after an Ivor Lewis oesophagectomy

A 66-year-old man underwent a minimally invasive oesophagectomy for oesophageal adenocarcinoma. Surgery and recovery were routine; however, he represented 8 days later with a massive upper gastrointestinal bleed. He was stabilized, but over a 2-week period experienced several bleeds requiring transfusion and multiple endoscopies, all showing a prominent luminal vessel at the oesophago-gastric (OG) anastomosis. Haemostatic clipping was attempted resulting in pulsatile bleeding and transfer to the radiology suite where angiography showed extravasation of contrast at the OG anastomosis from the terminal portion of the gastro-epiploic arcade. Coil embolization was successful and did not result in ischaemia. It was our standard to construct the OG anastomosis with the end-to-end anastomosis circular stapler (DST™ Series EEA™), 4.8-mm staple height. However, we now use the 3.5-mm staple height for improved haemostasis and ensure that the area for anastomosis is cleared of omental tissue so as not to incorporate a visible vessel.

Percutaneous Hepatobiliary Endoscopy in the Interventional Radiology Suite

Percutaneous transhepatic choledochoscopy and cholecystoscopy have a growing place in the interventional radiology suite. Patients with indwelling tubes who may have once been left with limited options for stone extraction, targeted biopsy, and/or chronic biliary stricture can now have comprehensive care of their disease process by an interventional radiologist. There are a variety of low-profile and large-profile devices available in the hospital that can be repurposed for use in the biliary system and gallbladder. In many situations, these tools can be used to render patients with limited transoral endoscopic options and chronic indwelling tubes, tube free. This article provides an introduction to biliary endoscopy and cholecystoscopy and their role for the interventional radiologist.

XperCT Sharpening Reconstruction for Cone-Beam Computed Tomography Guided Lung and Bone Interventions

C-arm cone-beam computed tomography (CBCT) is a valuable tool for three-dimensional navigation and mapping in the interventional radiology suite owing to its flexible gantry positioning, real-time three-dimensional volume acquisition, and reduced contrast and radiation use. Reports of CBCT-guided bone and lung interventions are relatively infrequent, however, possibly due in part to the lack of dedicated bone and lung reconstruction algorithms and concerns regarding insufficient lesion conspicuity. Two cases of an ad hoc intraprocedural CBCT sharpening reconstruction are presented in this article.