In some ways our approach to this issue was like a naive science experiment. Since we shared a satisfying professional collaboration at our prior jobs where we were part of a dynamic multidisciplinary group that included interventional radiologists and advanced endoscopists, when this opportunity to serve as co-guest editors was given to us, we started contemplating ways to revive our prior experience.
{"title":"I Do It My Way: Alternative Approaches in Multidisciplinary Management of GI Diseases","authors":"Sidhartha Tavri, Sagarika Satyavada","doi":"10.1055/s-0043-1771478","DOIUrl":"https://doi.org/10.1055/s-0043-1771478","url":null,"abstract":"In some ways our approach to this issue was like a naive science experiment. Since we shared a satisfying professional collaboration at our prior jobs where we were part of a dynamic multidisciplinary group that included interventional radiologists and advanced endoscopists, when this opportunity to serve as co-guest editors was given to us, we started contemplating ways to revive our prior experience.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135876152","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}
Many medical conditions require multidisciplinary care to achieve successful outcomes for patients. There are certain conditions that require management that cross the boundaries of specialties. Several gastrointestinal disorders require complex care be it due to the nature of the condition or the advent of newer technologies in the respective field. A few such disease processes will be covered in this issue of Digestive Disease Interventions (DDI)— I Do It My Way – Alternative Approaches in Multidisciplinary Management of GI Diseases. These conditions include gastric varices, gallbladder drainage, enteral access, pancreatic necrosis, and liver biopsy and portal pressure measurements. These conditions either have the option of being managed using different interventional techniques or require multidisciplinary management through the collaboration of interventional radiology, gastroenterology, and surgery.
{"title":"I Do It My Way: Alternative Approaches in Multidisciplinary Management of GI Diseases","authors":"Sagarika Satyavada, Sidhartha Tavri","doi":"10.1055/s-0043-1771479","DOIUrl":"https://doi.org/10.1055/s-0043-1771479","url":null,"abstract":"Many medical conditions require multidisciplinary care to achieve successful outcomes for patients. There are certain conditions that require management that cross the boundaries of specialties. Several gastrointestinal disorders require complex care be it due to the nature of the condition or the advent of newer technologies in the respective field. A few such disease processes will be covered in this issue of Digestive Disease Interventions (DDI)— I Do It My Way – Alternative Approaches in Multidisciplinary Management of GI Diseases. These conditions include gastric varices, gallbladder drainage, enteral access, pancreatic necrosis, and liver biopsy and portal pressure measurements. These conditions either have the option of being managed using different interventional techniques or require multidisciplinary management through the collaboration of interventional radiology, gastroenterology, and surgery.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"29 14","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135876153","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}
Juana V. Barrera, María del Pilar Bayona Molano, Vishal Kumar, Luis Cruz, Micaela Arrieta, Gina Landinez
Abstract Clinical research is an essential aspect of advancing medical knowledge, improving patient outcomes, and reducing the burden of diseases. However, there are significant discrepancies in access to high-quality research worldwide, particularly in Latin American countries. Despite being crucial for evidence of efficacy in clinical research, randomized controlled trials are relatively scarce in Latin America compared with developed countries like the United States. This article explores the challenges and limitations that Latin American researchers face when conducting health-related clinical trials, including lack of economic resources, political instability, language barriers, and scarcity of indexed journals. Moreover, this article sheds light on the challenges in the fields of diagnostic radiology and interventional radiology in Latin America, such as limited resources, inadequate infrastructure, low awareness of the importance of imaging for accurate diagnoses and treatment, lack of specialized training programs, few opportunities for research, and insufficient funding. Addressing these challenges is crucial for Latin American researchers to produce high-quality clinical research and contribute to global medical knowledge, ultimately improving health outcomes and quality of life for people worldwide.
{"title":"Medical Research Disparities in Latin America","authors":"Juana V. Barrera, María del Pilar Bayona Molano, Vishal Kumar, Luis Cruz, Micaela Arrieta, Gina Landinez","doi":"10.1055/s-0043-1775580","DOIUrl":"https://doi.org/10.1055/s-0043-1775580","url":null,"abstract":"Abstract Clinical research is an essential aspect of advancing medical knowledge, improving patient outcomes, and reducing the burden of diseases. However, there are significant discrepancies in access to high-quality research worldwide, particularly in Latin American countries. Despite being crucial for evidence of efficacy in clinical research, randomized controlled trials are relatively scarce in Latin America compared with developed countries like the United States. This article explores the challenges and limitations that Latin American researchers face when conducting health-related clinical trials, including lack of economic resources, political instability, language barriers, and scarcity of indexed journals. Moreover, this article sheds light on the challenges in the fields of diagnostic radiology and interventional radiology in Latin America, such as limited resources, inadequate infrastructure, low awareness of the importance of imaging for accurate diagnoses and treatment, lack of specialized training programs, few opportunities for research, and insufficient funding. Addressing these challenges is crucial for Latin American researchers to produce high-quality clinical research and contribute to global medical knowledge, ultimately improving health outcomes and quality of life for people worldwide.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135366501","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}
Alfonso Jose Holguín Holguín, Juan Sebastián Toro Gutierrez, Luis Alfonso Bustamante-Cristancho, Tatiana Alvarez Saa, Juan C. Camacho
Abstract Hepatocarcinoma (HCC) is the main cause of morbidity and mortality worldwide in patients with cirrhosis. Eighty percent of cases worldwide are due to infections with hepatitis B and C viruses, but nonalcoholic steatohepatitis (NASH) is projected to be an important etiology. It is usually diagnosed in advanced stages, only 15% of patients are surgical candidates, and up to 35% can receive only supportive care. This pathology has changed over time with the significant advances in treatment alternatives that can improve life expectancy for patients who are not surgical candidates. Therapeutic alternatives are available based on staging according to different models and the Barcelona Clinic Liver Cancer (BCLC) staging system. Systemic pharmacological options (neoadjuvant, adjuvant, and hormonal therapy), surgical options, and locoregional therapies have been developed; all these interventions have been directed to increase the life expectancy of some patients with variable results. Regional therapies include transarterial embolization (TAE) or bland embolization, transarterial infusion chemotherapy, conventional transarterial chemoembolization (TACE), drug-eluting bead transarterial chemoembolization (DEB-TACE), and transarterial radioembolization, with no substantial difference in outcomes between patients treated with TACE and those receiving DEB-TACE, but benefits of lower systemic adverse effects and improved of quality-adjusted life years measure with DEB-TACE. With the addition of immunotherapy to these interventions, the outcomes are expected to be even more impactful on main outcomes such as survival and disease-free survival.
{"title":"Bland Embolization and Transarterial Chemoembolization in Hepatocarcinoma","authors":"Alfonso Jose Holguín Holguín, Juan Sebastián Toro Gutierrez, Luis Alfonso Bustamante-Cristancho, Tatiana Alvarez Saa, Juan C. Camacho","doi":"10.1055/s-0043-1772742","DOIUrl":"https://doi.org/10.1055/s-0043-1772742","url":null,"abstract":"Abstract Hepatocarcinoma (HCC) is the main cause of morbidity and mortality worldwide in patients with cirrhosis. Eighty percent of cases worldwide are due to infections with hepatitis B and C viruses, but nonalcoholic steatohepatitis (NASH) is projected to be an important etiology. It is usually diagnosed in advanced stages, only 15% of patients are surgical candidates, and up to 35% can receive only supportive care. This pathology has changed over time with the significant advances in treatment alternatives that can improve life expectancy for patients who are not surgical candidates. Therapeutic alternatives are available based on staging according to different models and the Barcelona Clinic Liver Cancer (BCLC) staging system. Systemic pharmacological options (neoadjuvant, adjuvant, and hormonal therapy), surgical options, and locoregional therapies have been developed; all these interventions have been directed to increase the life expectancy of some patients with variable results. Regional therapies include transarterial embolization (TAE) or bland embolization, transarterial infusion chemotherapy, conventional transarterial chemoembolization (TACE), drug-eluting bead transarterial chemoembolization (DEB-TACE), and transarterial radioembolization, with no substantial difference in outcomes between patients treated with TACE and those receiving DEB-TACE, but benefits of lower systemic adverse effects and improved of quality-adjusted life years measure with DEB-TACE. With the addition of immunotherapy to these interventions, the outcomes are expected to be even more impactful on main outcomes such as survival and disease-free survival.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135644905","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}
Abstract The management of biliary pathology can be surgical, endoscopic, or percutaneous. Percutaneous interventions play an important role in the management of patients. Biliary drainage is the initial step in most radiological interventions, including percutaneous transhepatic cholangioscopy. It can be palliative or curative. We present here the different techniques available from interventional radiology. The purpose of this review article is to investigate the latest published evidence on percutaneous minimally invasive approach of biliary disease and outline current trends.
{"title":"Advanced Biliary Interventions: Gastrointestinal or Interventional Radiology Approach","authors":"Miguel Naranjo, Hector Ferral, Roberto Chavez","doi":"10.1055/s-0043-1774390","DOIUrl":"https://doi.org/10.1055/s-0043-1774390","url":null,"abstract":"Abstract The management of biliary pathology can be surgical, endoscopic, or percutaneous. Percutaneous interventions play an important role in the management of patients. Biliary drainage is the initial step in most radiological interventions, including percutaneous transhepatic cholangioscopy. It can be palliative or curative. We present here the different techniques available from interventional radiology. The purpose of this review article is to investigate the latest published evidence on percutaneous minimally invasive approach of biliary disease and outline current trends.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135345240","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}
Priscila Henriques da Silva, Rômulo Florêncio Tristão dos Santos, Denis Szejnfeld, Gloria Maria Martinez Salazar
Abstract Advanced schistosomiasis is an infectious disease, endemic in some regions, with long-term implications for patient care. It can be associated with conditions such as portal hypertension, variceal hemorrhage, chronic hepatic encephalopathy, and hepatocellular carcinoma. In this article, an overview of the most recent data about the role of interventional radiology in the management of these conditions will be presented, as well as the authors' experience on interventional management of schistosomiasis patients.
{"title":"Interventional Radiology Management of Advanced Schistosomiasis: State of the Art","authors":"Priscila Henriques da Silva, Rômulo Florêncio Tristão dos Santos, Denis Szejnfeld, Gloria Maria Martinez Salazar","doi":"10.1055/s-0043-1771313","DOIUrl":"https://doi.org/10.1055/s-0043-1771313","url":null,"abstract":"Abstract Advanced schistosomiasis is an infectious disease, endemic in some regions, with long-term implications for patient care. It can be associated with conditions such as portal hypertension, variceal hemorrhage, chronic hepatic encephalopathy, and hepatocellular carcinoma. In this article, an overview of the most recent data about the role of interventional radiology in the management of these conditions will be presented, as well as the authors' experience on interventional management of schistosomiasis patients.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"96 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135385366","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}
Varun Kesar, Vivek Kesar, Klaus Monkemuller, Paul Yeaton
Abstract Endoscopic ultrasound (EUS) has come a long way from mere diagnostic modality to performing interventional procedures like fine needle aspiration, gastric varices glue and coiling, and management of pancreatic fluid collection along with necrosectomy. Recently, EUS-guided biopsy of the liver has gained traction. This coupled with the ability to access the portal vein and measure portal pressure has made comprehensive liver evaluation possible using endoscopic route. In this review, we will discuss evolution and techniques of performing EUS-guided liver biopsy and portal pressure gradient. We will also compare the merits and demerits as compared with the other conventional techniques.
{"title":"Liver Biopsy and Pressure Hemodynamics: GI Perspective","authors":"Varun Kesar, Vivek Kesar, Klaus Monkemuller, Paul Yeaton","doi":"10.1055/s-0043-1771480","DOIUrl":"https://doi.org/10.1055/s-0043-1771480","url":null,"abstract":"Abstract Endoscopic ultrasound (EUS) has come a long way from mere diagnostic modality to performing interventional procedures like fine needle aspiration, gastric varices glue and coiling, and management of pancreatic fluid collection along with necrosectomy. Recently, EUS-guided biopsy of the liver has gained traction. This coupled with the ability to access the portal vein and measure portal pressure has made comprehensive liver evaluation possible using endoscopic route. In this review, we will discuss evolution and techniques of performing EUS-guided liver biopsy and portal pressure gradient. We will also compare the merits and demerits as compared with the other conventional techniques.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"166 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135149177","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}
Camilo Barragan, Alonso Vera, Sergio Hoyos, Diana Bejarano, Ana Maria Lopez-Ruiz, Francisco Grippi, Alejandro Mejia, María del Pilar Bayona Molano
Abstract Liver transplant patients require a multidisciplinary and personalized approach to optimize outcomes. Posttransplant complications can be devastating for the patient and can jeopardize graft survival. Therefore, a careful evaluation and stepwise decision-making process is necessary to determine the best strategy, whether it is surgical, interventional, or a combination of both. While access to liver transplant interventions in Latin America can be more limited compared with other parts of the world, many countries in the region have made significant progress in developing their liver transplant programs and improving the management of posttransplant complications. For example, in Brazil, specialized transplant centers and multidisciplinary teams have been established to reduce morbidity and improve graft survival rates. The article also explores the latest advancements in interventional radiology techniques, such as angioplasty, stent placement, and embolization, and how they can be used to successfully treat these complications. Overall, this article highlights the importance of a comprehensive approach to managing complications in liver transplant patients and emphasizes how individualized treatment plans can lead to improved outcomes, even in settings with limited resources.
{"title":"Surgical and Interventional Radiology Management of Vascular and Biliary Complications in Liver Transplantation: Narrative Review","authors":"Camilo Barragan, Alonso Vera, Sergio Hoyos, Diana Bejarano, Ana Maria Lopez-Ruiz, Francisco Grippi, Alejandro Mejia, María del Pilar Bayona Molano","doi":"10.1055/s-0043-1774321","DOIUrl":"https://doi.org/10.1055/s-0043-1774321","url":null,"abstract":"Abstract Liver transplant patients require a multidisciplinary and personalized approach to optimize outcomes. Posttransplant complications can be devastating for the patient and can jeopardize graft survival. Therefore, a careful evaluation and stepwise decision-making process is necessary to determine the best strategy, whether it is surgical, interventional, or a combination of both. While access to liver transplant interventions in Latin America can be more limited compared with other parts of the world, many countries in the region have made significant progress in developing their liver transplant programs and improving the management of posttransplant complications. For example, in Brazil, specialized transplant centers and multidisciplinary teams have been established to reduce morbidity and improve graft survival rates. The article also explores the latest advancements in interventional radiology techniques, such as angioplasty, stent placement, and embolization, and how they can be used to successfully treat these complications. Overall, this article highlights the importance of a comprehensive approach to managing complications in liver transplant patients and emphasizes how individualized treatment plans can lead to improved outcomes, even in settings with limited resources.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135938516","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}
Abstract Gastrostomy tube placement may be needed for nutritional support, as in the setting of neurogenic dysphagia or head and neck malignancy, or for gastric decompression, as in the setting of malignant small bowel obstruction. Additionally, gastrojejunostomy or direct jejunostomy tubes may be needed in the setting of gastric outlet obstruction among other indications. Surgical, endoscopic, and percutaneous approaches are all well-described with generally similar outcomes. In this article, the standard radiologic percutaneous gastrostomy technique is reviewed including both the “push” and “pull” methods. Then, the special indications and techniques of advanced percutaneous enteral access such as percutaneous transesophageal gastrostomy and direct jejunostomy are discussed with examples shown.
{"title":"Enteric Access: IR Perspective","authors":"Marc Michael Del Rosario Lim","doi":"10.1055/s-0043-1771310","DOIUrl":"https://doi.org/10.1055/s-0043-1771310","url":null,"abstract":"Abstract Gastrostomy tube placement may be needed for nutritional support, as in the setting of neurogenic dysphagia or head and neck malignancy, or for gastric decompression, as in the setting of malignant small bowel obstruction. Additionally, gastrojejunostomy or direct jejunostomy tubes may be needed in the setting of gastric outlet obstruction among other indications. Surgical, endoscopic, and percutaneous approaches are all well-described with generally similar outcomes. In this article, the standard radiologic percutaneous gastrostomy technique is reviewed including both the “push” and “pull” methods. Then, the special indications and techniques of advanced percutaneous enteral access such as percutaneous transesophageal gastrostomy and direct jejunostomy are discussed with examples shown.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135981721","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}
Abstract Enteric access is the main method to obtain nutrition in patients with normally functioning gastrointestinal tract who are otherwise unable to feed orally. Enteric access can be obtained through the nose, mouth, or skin by a nurse, general practitioner, endoscopist, interventional radiologist, or a surgeon. In this article, we review the different types of feeding tubes, indications, contraindications, and potential complications.
{"title":"Enteric Access: Gastrointestinal Perspective","authors":"K. Zakharia","doi":"10.1055/s-0043-1771309","DOIUrl":"https://doi.org/10.1055/s-0043-1771309","url":null,"abstract":"Abstract Enteric access is the main method to obtain nutrition in patients with normally functioning gastrointestinal tract who are otherwise unable to feed orally. Enteric access can be obtained through the nose, mouth, or skin by a nurse, general practitioner, endoscopist, interventional radiologist, or a surgeon. In this article, we review the different types of feeding tubes, indications, contraindications, and potential complications.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"62 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73702584","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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