Deniz Demircioglu, Lou-Anne Acevedo Moreno, William A. Hall
Cholangiocarcinoma (CCA) is a malignancy of epithelial cells in the bile duct, categorized based on its anatomical location as intrahepatic, perihilar, or extrahepatic. It has a low prevalence of ∼1.6 cases per 100,000 people in the United States, but has a poor prognosis. All stages included, CCA has a 5-year survival rate of less than 10%. The preferred curative treatment for intrahepatic, perihilar, and extrahepatic CCA is surgical resection combined with systemic chemotherapy. However, resection is not always a viable option for many patients, as the disease is often discovered at the time of diagnosis to be either metastatic or locally advanced precluding surgical resection. In this setting, a variety of options can be used, one of which is radiation therapy (RT). The administration of RT has evolved tremendously over the past decades. Total doses given can be limited by a tumor's proximity to regional normal organs such as the liver, stomach, bile duct, and small and large bowel. When a CCA is unresectable, it is often in close proximity to radiosensitive organs. Delivering RT in this setting therefore requires precise delivery techniques. An emerging technique known broadly as stereotactic body radiation therapy (SBRT) or stereotactic ablative body radiation therapy gives a highly focused, often ablative, form of RT to a defined and specific target. Categorically, SBRT offers a quick and efficient management option, in some cases only one to three total treatments. This narrative reviews various applications of SBRT for cholangiocarcinoma including SBRT alone, SBRT with chemotherapy, SBRT with chemotherapy followed by a liver transplantation (orthotopic liver transplantation), and finally novel combinations of SBRT with immunotherapy.
胆管癌（Colangiocarcinoma，CCA）是胆管上皮细胞的恶性肿瘤，根据解剖位置分为肝内、肝周或肝外。在美国，其发病率较低，每 10 万人中仅有 1.6 例，但预后较差。包括所有分期在内，CCA 的 5 年生存率不到 10%。肝内、肝周和肝外 CCA 的首选根治性治疗方法是手术切除联合全身化疗。然而，手术切除对许多患者来说并不总是可行的选择，因为在诊断时往往发现疾病已经转移或局部晚期，无法进行手术切除。在这种情况下，可以采用多种方案，其中之一就是放射治疗（RT）。在过去的几十年中，放射治疗的应用发生了巨大的变化。由于肿瘤靠近肝脏、胃、胆管、小肠和大肠等区域正常器官，因此总剂量会受到限制。当 CCA 无法切除时，它往往靠近放射敏感器官。因此，在这种情况下进行 RT 需要精确的给药技术。一种被广泛称为立体定向体放射治疗（SBRT）或立体定向烧蚀体放射治疗的新兴技术可对确定的特定靶点进行高度集中的、通常是烧蚀性的 RT 治疗。总体而言，SBRT 提供了一种快速高效的治疗方案，在某些情况下只需一到三次治疗。本文回顾了SBRT在胆管癌治疗中的各种应用，包括单独使用SBRT、SBRT联合化疗、SBRT联合化疗后进行肝移植（正位肝移植），以及SBRT与免疫疗法的新型组合。
{"title":"Management of Unresectable Cholangiocarcinoma Using Modern Radiation Therapy Techniques","authors":"Deniz Demircioglu, Lou-Anne Acevedo Moreno, William A. Hall","doi":"10.1055/s-0044-1788557","DOIUrl":"https://doi.org/10.1055/s-0044-1788557","url":null,"abstract":"Cholangiocarcinoma (CCA) is a malignancy of epithelial cells in the bile duct, categorized based on its anatomical location as intrahepatic, perihilar, or extrahepatic. It has a low prevalence of ∼1.6 cases per 100,000 people in the United States, but has a poor prognosis. All stages included, CCA has a 5-year survival rate of less than 10%. The preferred curative treatment for intrahepatic, perihilar, and extrahepatic CCA is surgical resection combined with systemic chemotherapy. However, resection is not always a viable option for many patients, as the disease is often discovered at the time of diagnosis to be either metastatic or locally advanced precluding surgical resection. In this setting, a variety of options can be used, one of which is radiation therapy (RT). The administration of RT has evolved tremendously over the past decades. Total doses given can be limited by a tumor's proximity to regional normal organs such as the liver, stomach, bile duct, and small and large bowel. When a CCA is unresectable, it is often in close proximity to radiosensitive organs. Delivering RT in this setting therefore requires precise delivery techniques. An emerging technique known broadly as stereotactic body radiation therapy (SBRT) or stereotactic ablative body radiation therapy gives a highly focused, often ablative, form of RT to a defined and specific target. Categorically, SBRT offers a quick and efficient management option, in some cases only one to three total treatments. This narrative reviews various applications of SBRT for cholangiocarcinoma including SBRT alone, SBRT with chemotherapy, SBRT with chemotherapy followed by a liver transplantation (orthotopic liver transplantation), and finally novel combinations of SBRT with immunotherapy.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":" 27","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141830037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Interventional radiology (IR) is a rapidly developing field among medical activities. This review summarizes the history of IR since the inception of angiography, the present situation regarding IR's position in the clinical setting, and proposal of standardized education and further cooperation in the field. This review also focuses on sharing the author's experience in establishing an extensive IR service line, and how this will become the standard model for the Vietnamese Society of Interventional Radiology.
介入放射学（IR）是医疗活动中发展迅速的领域。本综述总结了介入放射学自血管造影术诞生以来的历史、介入放射学在临床中的地位现状，以及在该领域开展标准化教育和进一步合作的建议。本综述还重点分享了作者在建立广泛的 IR 服务线方面的经验，以及如何将其作为越南介入放射学会的标准模式。
{"title":"Developing an Interventional Radiology Service","authors":"Luan D. Nguyen","doi":"10.1055/s-0044-1787097","DOIUrl":"https://doi.org/10.1055/s-0044-1787097","url":null,"abstract":"Interventional radiology (IR) is a rapidly developing field among medical activities. This review summarizes the history of IR since the inception of angiography, the present situation regarding IR's position in the clinical setting, and proposal of standardized education and further cooperation in the field. This review also focuses on sharing the author's experience in establishing an extensive IR service line, and how this will become the standard model for the Vietnamese Society of Interventional Radiology.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"4 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141646165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gastric varices (GVs) and hepatic encephalopathy (HE) are major complications of portal hypertension in patients with liver cirrhosis. As most of the GVs drain into the left renal vein via a portosystemic shunt, the concept of retrograde treatment approach such as balloon-occluded retrograde transvenous obliteration using sclerosing agents has been introduced. Recently, plug-assisted retrograde transvenous obliteration (PARTO) has been alternatively performed, which uses vascular plug and gelfoam. PARTO utilizes a permanent vascular plug to reduce postprocedural monitoring time as well as to avoid the risk of balloon rupture–related complications. It also eliminates the sclerosing agents–related complications with the use of gelfoam as an embolics. In this review, we introduce technical aspects of PARTO and outline its potential for use as the treatment of GVs and HE.
胃静脉曲张（GV）和肝性脑病（HE）是肝硬化患者门静脉高压症的主要并发症。由于大多数胃静脉曲张通过门静脉分流排入左肾静脉，因此出现了逆行治疗的概念，如使用硬化剂进行球囊闭塞逆行经静脉阻塞。最近，又出现了使用血管堵塞物和凝胶泡沫的堵塞物辅助逆行经静脉阻塞术（PARTO）。PARTO 使用永久性血管塞，以减少术后监测时间，并避免球囊破裂相关并发症的风险。它还避免了使用硬化剂作为栓塞物所带来的相关并发症。在这篇综述中，我们将介绍 PARTO 的技术方面，并概述其用于治疗 GV 和 HE 的潜力。
{"title":"Plug-Assisted Retrograde Transvenous Obliteration: A Modified Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices","authors":"Dong Il Gwon, Hyun-Ki Yoon","doi":"10.1055/s-0044-1786794","DOIUrl":"https://doi.org/10.1055/s-0044-1786794","url":null,"abstract":"Gastric varices (GVs) and hepatic encephalopathy (HE) are major complications of portal hypertension in patients with liver cirrhosis. As most of the GVs drain into the left renal vein via a portosystemic shunt, the concept of retrograde treatment approach such as balloon-occluded retrograde transvenous obliteration using sclerosing agents has been introduced. Recently, plug-assisted retrograde transvenous obliteration (PARTO) has been alternatively performed, which uses vascular plug and gelfoam. PARTO utilizes a permanent vascular plug to reduce postprocedural monitoring time as well as to avoid the risk of balloon rupture–related complications. It also eliminates the sclerosing agents–related complications with the use of gelfoam as an embolics. In this review, we introduce technical aspects of PARTO and outline its potential for use as the treatment of GVs and HE.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"24 27","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141645832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ritu Shah, Pareena Sharma, Darshan Variyam, Michael Leshen, Fredric J. Bertino, Vaz Zavaletta, Jay Shah
Liver transplantation (LT) is a common solid organ transplant in the pediatric population. The common indications for LT, as well as its complications, differ between adults and children. This difference necessitates unique pediatric interventional radiology (IR) interventions. This article focuses on unique vascular complications occurring post-pediatric LT and highlights the importance of IR in their management. It explores IR's involvement in the workup of patients' pre-LT and management of complications following portosystemic shunts. We discuss advantages and disadvantages of different access routes as well as the prevalence, clinical picture, diagnosis, and management of complications after pediatric LT. These complications encompass portal vein stenosis, portal vein thrombosis, hepatic artery stenosis, hepatic artery thrombosis, hepatic artery pseudoaneurysm, arterioportal fistula, hepatic vein stenosis, and inferior vena cava stenosis. The choice of endovascular technique for a clinical indication depends on vascular anatomy, time since LT, and patient-specific factors. Transsplenic access is a useful alternative to transhepatic or transjugular access. The decision to place a stent in a child is influenced by the expected growth of the child and risk of focal narrowing at stent edge (because of recipient growth). Technical challenges in pediatric patient management, including uncooperative patients and sedation issues, must be considered. Pediatric LT complications can present with significant challenges in the posttransplant care of recipients and may lead to serious morbidity and graft failure if not managed effectively. IR techniques like balloon angioplasty, stent placement, thrombolysis, and embolization have demonstrated success in treating these complications, improving patient outcomes, and reducing long-term morbidity and mortality. By enhancing the understanding of medical practitioners and interventional radiologists about complex vascular complications, this article aims to contribute to better posttransplant care and improved outcomes for LT in pediatric populations. Continued collaboration between specialties and research will advance the field of pediatric LT and IR, to create even more effective treatment strategies.
{"title":"Role of Interventional Radiology in the Management of Liver Transplant Complications in Children","authors":"Ritu Shah, Pareena Sharma, Darshan Variyam, Michael Leshen, Fredric J. Bertino, Vaz Zavaletta, Jay Shah","doi":"10.1055/s-0044-1785200","DOIUrl":"https://doi.org/10.1055/s-0044-1785200","url":null,"abstract":"Liver transplantation (LT) is a common solid organ transplant in the pediatric population. The common indications for LT, as well as its complications, differ between adults and children. This difference necessitates unique pediatric interventional radiology (IR) interventions. This article focuses on unique vascular complications occurring post-pediatric LT and highlights the importance of IR in their management. It explores IR's involvement in the workup of patients' pre-LT and management of complications following portosystemic shunts. We discuss advantages and disadvantages of different access routes as well as the prevalence, clinical picture, diagnosis, and management of complications after pediatric LT. These complications encompass portal vein stenosis, portal vein thrombosis, hepatic artery stenosis, hepatic artery thrombosis, hepatic artery pseudoaneurysm, arterioportal fistula, hepatic vein stenosis, and inferior vena cava stenosis. The choice of endovascular technique for a clinical indication depends on vascular anatomy, time since LT, and patient-specific factors. Transsplenic access is a useful alternative to transhepatic or transjugular access. The decision to place a stent in a child is influenced by the expected growth of the child and risk of focal narrowing at stent edge (because of recipient growth). Technical challenges in pediatric patient management, including uncooperative patients and sedation issues, must be considered. Pediatric LT complications can present with significant challenges in the posttransplant care of recipients and may lead to serious morbidity and graft failure if not managed effectively. IR techniques like balloon angioplasty, stent placement, thrombolysis, and embolization have demonstrated success in treating these complications, improving patient outcomes, and reducing long-term morbidity and mortality. By enhancing the understanding of medical practitioners and interventional radiologists about complex vascular complications, this article aims to contribute to better posttransplant care and improved outcomes for LT in pediatric populations. Continued collaboration between specialties and research will advance the field of pediatric LT and IR, to create even more effective treatment strategies.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"2 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141099065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cholangiocarcinoma (CCA) is an uncommon but morbid cancer arising from the intrahepatic or extrahepatic bile ducts. CCA is frequently asymptomatic at early stages and is often unresectable or metastatic at the time of initial diagnosis. While chemotherapy remains the mainstay of treatment for most patients with advanced disease, the addition of immunotherapy to frontline treatment has improved survival and provided an alternative to perpetual chemotherapy. Furthermore, a variety of targeted therapies have demonstrated benefit in patients with specific biomarkers including FGFR2 fusions, IDH1 mutations, HER2 overexpression, and tumor agnostic markers such as NTRK and RET fusions, among others. This review will summarize the established roles of immunotherapy, targeted therapies, and their combinations in CCA as well as treatment strategies that are under development with potential to impact clinical practice in the coming years.
胆管癌（Colangiocarcinoma，CCA）是一种不常见但发病率很高的癌症，它发生于肝内或肝外胆管。CCA 在早期阶段通常没有症状，在初次诊断时往往无法切除或已经转移。虽然化疗仍是大多数晚期患者的主要治疗手段，但在一线治疗中加入免疫疗法后，患者的生存率得到了提高，并为长期化疗提供了一种替代方案。此外，多种靶向疗法已证明对具有特定生物标志物的患者有益，这些标志物包括 FGFR2 融合、IDH1 突变、HER2 过表达以及 NTRK 和 RET 融合等肿瘤不可知标志物。本综述将总结免疫疗法、靶向疗法及其联合疗法在 CCA 中的既定作用，以及正在开发并有可能在未来几年对临床实践产生影响的治疗策略。
{"title":"Advances in Immunooncology and Precision Medicine in Cholangiocarcinoma","authors":"Timothy J. Brown, T. Karasic","doi":"10.1055/s-0044-1787013","DOIUrl":"https://doi.org/10.1055/s-0044-1787013","url":null,"abstract":"Cholangiocarcinoma (CCA) is an uncommon but morbid cancer arising from the intrahepatic or extrahepatic bile ducts. CCA is frequently asymptomatic at early stages and is often unresectable or metastatic at the time of initial diagnosis. While chemotherapy remains the mainstay of treatment for most patients with advanced disease, the addition of immunotherapy to frontline treatment has improved survival and provided an alternative to perpetual chemotherapy. Furthermore, a variety of targeted therapies have demonstrated benefit in patients with specific biomarkers including FGFR2 fusions, IDH1 mutations, HER2 overexpression, and tumor agnostic markers such as NTRK and RET fusions, among others. This review will summarize the established roles of immunotherapy, targeted therapies, and their combinations in CCA as well as treatment strategies that are under development with potential to impact clinical practice in the coming years.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"35 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140975822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this study is to describe the technical procedure, patency, and complications of percutaneous biliary plastic stent insertion following failure of the endoscopic approach. The data from 11 patients who underwent percutaneous plastic biliary stent placement following endoscopic approach failure between March 2022 and December 2023 were retrospectively evaluated. Stent placement was successful in all patients. Reduction of the total serum bilirubin level was achieved in all patients. No major complications occurred in all patients. A plastic stent provided enough drainage for patients with patency in our studies for up to 5 months.
{"title":"Placing Plastic Stent via Percutaneous Transhepatic Biliary Drainage following Failure of Endoscopic Retrograde Cholangiopancreatography: Review of Case Series","authors":"Antonius Gunawan Santoso, Nurdopo Baskoro, Novia Nathania Beatrice, Tanya Edwina, Bernadus Parish Budiono","doi":"10.1055/s-0044-1786696","DOIUrl":"https://doi.org/10.1055/s-0044-1786696","url":null,"abstract":"The aim of this study is to describe the technical procedure, patency, and complications of percutaneous biliary plastic stent insertion following failure of the endoscopic approach. The data from 11 patients who underwent percutaneous plastic biliary stent placement following endoscopic approach failure between March 2022 and December 2023 were retrospectively evaluated. Stent placement was successful in all patients. Reduction of the total serum bilirubin level was achieved in all patients. No major complications occurred in all patients. A plastic stent provided enough drainage for patients with patency in our studies for up to 5 months.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141025953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lymphatic leakage is a relatively rare complication following various surgical procedures. Occasionally, conservative treatments fail to control postoperative lymphatic leakage. Refractory lymphatic leakage causes severe morbidities, including malnutrition, immunodeficiency, and impaired wound healing. Lymphangiography is a useful method for identifying various types of lymphatic leakage. Recently, lipiodol lymphangiography has been popular for its potential therapeutic effects on refractory lymphatic leakage, but this technique remains underdeveloped. This review discusses lymphatic interventional radiology for postoperative lymphatic leakage.
{"title":"Lymphatic Interventional Radiology for Postoperative Lymphatic Leakage","authors":"Yozo Sato, Kiyoshi Matsueda, Yoshitaka Inaba, Satoshi Tsuchiya, Masayoshi Yamamoto, Tetsuya Abe","doi":"10.1055/s-0044-1786040","DOIUrl":"https://doi.org/10.1055/s-0044-1786040","url":null,"abstract":"Lymphatic leakage is a relatively rare complication following various surgical procedures. Occasionally, conservative treatments fail to control postoperative lymphatic leakage. Refractory lymphatic leakage causes severe morbidities, including malnutrition, immunodeficiency, and impaired wound healing. Lymphangiography is a useful method for identifying various types of lymphatic leakage. Recently, lipiodol lymphangiography has been popular for its potential therapeutic effects on refractory lymphatic leakage, but this technique remains underdeveloped. This review discusses lymphatic interventional radiology for postoperative lymphatic leakage.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":" 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140688563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prof. Nadia Abdelaaty Abdelkader, Prof. Mohammed El-Naggar, Prof. Waheed Tantawy, Prof. Mohammad Amin Sakr, Prof. Eman Abdel-Salam Ibrahim, Mohammed Abo Zaid, Ahmad F. Sherief, Assoc. Prof. Ahmed S. Abdelmoaty
Ascites is a common clinical problem, which can be a result of liver cirrhosis, neoplasm, tuberculous or pyogenic peritonitis, heart failure, nephrosis, and pancreatic disorders. This study aimed to evaluate the role of imaging-guided peritoneal biopsy in the diagnosis of ascites of unknown origin (ascites of local cause). Sixty-three patients with ascites of unknown etiology were included. Abdominal ultrasonography (US) with colored Duplex was performed, followed by laboratory investigations such as, ascitic fluid samples, magnetic resonance imaging, multislice computed tomography (CT), or PET/CT scan (if indicated). Imaging-guided peritoneal biopsy such as US-guided or CT-guided percutaneous peritoneal biopsy (in cases of failure of US-guided technique) of omentum or extravisceral masses was performed. Cytological and histopathological examinations of the tissue specimens were done by a single experienced pathologist. Other more invasive procedures (e.g., laparoscopy) were needed when the imaging-guided biopsy was not diagnostic. Fifty-four patients underwent US-guided biopsies, 48 patients were successfully diagnosed, and other 9 patients underwent CT-guided biopsies (not accessible by US-guided modality); laparoscopy was needed only in 6 patients. Malignant peritoneal pathology was found in 48 patients, while tuberculous peritonitis was diagnosed in 14 patients. Imaging-guided biopsies had perfect sensitivity (100%) and negative predictive value (100%) in differentiating neoplastic lesions. Percutaneous imaging-guided biopsy (US/CT guided) of the peritoneum, omenta, and mesentery has been established as a safe, simple, noninvasive, and well-tolerated procedure with high diagnostic accuracy. It can minimize further unnecessary invasive procedures such as laparoscopy.
腹水是一种常见的临床问题，可由肝硬化、肿瘤、结核性或化脓性腹膜炎、心力衰竭、肾病和胰腺疾病引起。本研究旨在评估成像引导腹膜活检在诊断不明原因腹水（局部原因腹水）中的作用。研究共纳入 63 名病因不明腹水患者。他们接受了腹部超声波检查（US）和彩色多普勒检查，随后进行了实验室检查，如腹水样本、磁共振成像、多层计算机断层扫描（CT）或正电子发射计算机断层扫描（PET/CT）（如有必要）。对网膜或内脏外肿块进行图像引导的腹膜活检，如 US 引导或 CT 引导的经皮腹膜活检（在 US 引导技术失败的情况下）。组织标本的细胞学和组织病理学检查由一名经验丰富的病理学家完成。如果影像引导活检不能确诊，则需要进行其他更具侵入性的手术（如腹腔镜手术）。54名患者接受了US引导活检，48名患者成功确诊，另外9名患者接受了CT引导活检（US引导方式无法进行）；只有6名患者需要进行腹腔镜检查。48 名患者发现了恶性腹膜病变，14 名患者确诊为结核性腹膜炎。成像引导活检在区分肿瘤病变方面具有完美的灵敏度（100%）和阴性预测值（100%）。腹膜、网膜和肠系膜的经皮成像引导活检（US/CT 引导）已被证实是一种安全、简单、无创、耐受性好且诊断准确率高的手术。它可以最大限度地减少腹腔镜等不必要的侵入性手术。
{"title":"Evaluation of Imaging-Guided Peritoneal Biopsy in Diagnosis of Ascites of Unknown Origin","authors":"Prof. Nadia Abdelaaty Abdelkader, Prof. Mohammed El-Naggar, Prof. Waheed Tantawy, Prof. Mohammad Amin Sakr, Prof. Eman Abdel-Salam Ibrahim, Mohammed Abo Zaid, Ahmad F. Sherief, Assoc. Prof. Ahmed S. Abdelmoaty","doi":"10.1055/s-0043-1772580","DOIUrl":"https://doi.org/10.1055/s-0043-1772580","url":null,"abstract":"Ascites is a common clinical problem, which can be a result of liver cirrhosis, neoplasm, tuberculous or pyogenic peritonitis, heart failure, nephrosis, and pancreatic disorders. This study aimed to evaluate the role of imaging-guided peritoneal biopsy in the diagnosis of ascites of unknown origin (ascites of local cause). Sixty-three patients with ascites of unknown etiology were included. Abdominal ultrasonography (US) with colored Duplex was performed, followed by laboratory investigations such as, ascitic fluid samples, magnetic resonance imaging, multislice computed tomography (CT), or PET/CT scan (if indicated). Imaging-guided peritoneal biopsy such as US-guided or CT-guided percutaneous peritoneal biopsy (in cases of failure of US-guided technique) of omentum or extravisceral masses was performed. Cytological and histopathological examinations of the tissue specimens were done by a single experienced pathologist. Other more invasive procedures (e.g., laparoscopy) were needed when the imaging-guided biopsy was not diagnostic. Fifty-four patients underwent US-guided biopsies, 48 patients were successfully diagnosed, and other 9 patients underwent CT-guided biopsies (not accessible by US-guided modality); laparoscopy was needed only in 6 patients. Malignant peritoneal pathology was found in 48 patients, while tuberculous peritonitis was diagnosed in 14 patients. Imaging-guided biopsies had perfect sensitivity (100%) and negative predictive value (100%) in differentiating neoplastic lesions. Percutaneous imaging-guided biopsy (US/CT guided) of the peritoneum, omenta, and mesentery has been established as a safe, simple, noninvasive, and well-tolerated procedure with high diagnostic accuracy. It can minimize further unnecessary invasive procedures such as laparoscopy.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"73 S326","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140694792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"DDI Meets Latin America","authors":"M. B. Bayona Molano, G. Salazar","doi":"10.1055/s-0043-1774336","DOIUrl":"https://doi.org/10.1055/s-0043-1774336","url":null,"abstract":"","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140413203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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