Abstract Cholecystitis and gallbladder disease are an important, growing, and costly problem. As interventional radiology (IR) and gastroenterology (GI) have evolved and become even more minimally invasive and technically capable, we play an increasingly important role in the management of cholecystitis, particularly in nonsurgical and palliative settings. This review highlights the modern and future role of IR and GI in gallbladder drainage for the management of acute cholecystitis.
{"title":"Gallbladder Drainage: IR and GI Perspective","authors":"A. Vezeridis, Sagarika Satyavada, M. Barakat","doi":"10.1055/s-0043-1771308","DOIUrl":"https://doi.org/10.1055/s-0043-1771308","url":null,"abstract":"Abstract Cholecystitis and gallbladder disease are an important, growing, and costly problem. As interventional radiology (IR) and gastroenterology (GI) have evolved and become even more minimally invasive and technically capable, we play an increasingly important role in the management of cholecystitis, particularly in nonsurgical and palliative settings. This review highlights the modern and future role of IR and GI in gallbladder drainage for the management of acute cholecystitis.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87410941","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}
Although its exact origin is unknown, the familiar Latin axiom Primum non nocere (first, do no harm) has been spoken or thought by all physicians and healthcare providers at one time or another. For those of us who perform invasive procedures or surgery, this phrase lives deep within our psyche as we never want to have a complication ensue from any procedure causing injury to those we are trying to help. However, the only interventionalist who has never had a complication is the one who has never actually practiced his or her craft. All of us remember our complications much more than our successful cases and, because of this, we learn much more from procedures that go awry than from those that go smoothly. Fortunately, and much more often than not, clinical outcomes can be the same regardless of procedure-related complications provided we have the knowledge and tools to deal with complications and iatrogenic injuries when they occur. To remember another proverb written by the founder of America's first hospital—Benjamin Franklin—An ounce of prevention is worth a pound of cure.
虽然它的确切起源是未知的，熟悉的拉丁公理Primum non nocere(首先，不伤害)已经被所有的医生和医疗保健提供者在一个或另一个时间说或认为。对于我们这些进行侵入性手术的人来说，这句话深深地印在我们的心里，因为我们不想让任何手术造成的并发症伤害到我们试图帮助的人。然而，唯一从未有过并发症的干预主义者是那些从未真正练习过他或她的手艺的人。我们所有人对并发症的记忆要比成功的病例多得多，正因为如此，我们从出错的过程中学到的东西要比从顺利的过程中学到的多得多。幸运的是，通常情况下，只要我们有知识和工具来处理并发症和医源性损伤，无论手术相关的并发症如何，临床结果都是一样的。记住美国第一所医院的创始人本杰明·富兰克林所写的另一句谚语:一盎司的预防胜过十分的治疗。
{"title":"Iatrogenic Injuries","authors":"Paula M. Novelli, Philip D. Orons","doi":"10.1055/s-0043-1768213","DOIUrl":"https://doi.org/10.1055/s-0043-1768213","url":null,"abstract":"Although its exact origin is unknown, the familiar Latin axiom Primum non nocere (first, do no harm) has been spoken or thought by all physicians and healthcare providers at one time or another. For those of us who perform invasive procedures or surgery, this phrase lives deep within our psyche as we never want to have a complication ensue from any procedure causing injury to those we are trying to help. However, the only interventionalist who has never had a complication is the one who has never actually practiced his or her craft. All of us remember our complications much more than our successful cases and, because of this, we learn much more from procedures that go awry than from those that go smoothly. Fortunately, and much more often than not, clinical outcomes can be the same regardless of procedure-related complications provided we have the knowledge and tools to deal with complications and iatrogenic injuries when they occur. To remember another proverb written by the founder of America's first hospital—Benjamin Franklin—An ounce of prevention is worth a pound of cure.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"86 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134959667","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}
C. Vozzo, V. Chittajallu, Brooke Glessing, A. Faulx, A. Chak, R. Wong
Abstract There is a paucity of literature on the management of gastric varices and current guidelines rely heavily on expert opinion. Optimal treatment of gastric varices requires a multidisciplinary team including gastrointestinal endoscopist, hepatologist, and interventional radiologists. Initial management relies on endoscopic diagnosis followed by therapeutic modalities based on the experience of the endoscopist and the institution. Definitive management may be endoscopic, endovascular, or a combination of the two disciplines. In this review, we discuss endoscopic management of gastric varices with direct endoscopic glue injection, endoscopic ultrasound-guided management, limitations, and adverse events. We conclude by describing a case of gastric variceal bleeding managed with endoscopy when interventional radiographic techniques were not feasible.
{"title":"Management of Gastric Varices: GI Perspective","authors":"C. Vozzo, V. Chittajallu, Brooke Glessing, A. Faulx, A. Chak, R. Wong","doi":"10.1055/s-0043-1771307","DOIUrl":"https://doi.org/10.1055/s-0043-1771307","url":null,"abstract":"Abstract There is a paucity of literature on the management of gastric varices and current guidelines rely heavily on expert opinion. Optimal treatment of gastric varices requires a multidisciplinary team including gastrointestinal endoscopist, hepatologist, and interventional radiologists. Initial management relies on endoscopic diagnosis followed by therapeutic modalities based on the experience of the endoscopist and the institution. Definitive management may be endoscopic, endovascular, or a combination of the two disciplines. In this review, we discuss endoscopic management of gastric varices with direct endoscopic glue injection, endoscopic ultrasound-guided management, limitations, and adverse events. We conclude by describing a case of gastric variceal bleeding managed with endoscopy when interventional radiographic techniques were not feasible.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82399135","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 Interventional radiology (IR) training is not uniform throughout the world with clear limitations to education, training, and procedural exposure based on regions within different countries and the world. Varying technical exposure can lead to limitations in technical and therapeutic opportunities for patients. Since hands-on exposure to specific procedural skills may not occur in some locations, high fidelity endovascular simulation training can provide an opportunity for technical skills to be learned with an effort to increase patient exposure to care as well as improve technical procedural skill learning.
{"title":"Regional Differences in Education: Can We Bridge that Gap with Simulation-Based Training?","authors":"A. Kesselman, V. A. V. Fornazari, R. Winokur","doi":"10.1055/s-0043-1772852","DOIUrl":"https://doi.org/10.1055/s-0043-1772852","url":null,"abstract":"Abstract Interventional radiology (IR) training is not uniform throughout the world with clear limitations to education, training, and procedural exposure based on regions within different countries and the world. Varying technical exposure can lead to limitations in technical and therapeutic opportunities for patients. Since hands-on exposure to specific procedural skills may not occur in some locations, high fidelity endovascular simulation training can provide an opportunity for technical skills to be learned with an effort to increase patient exposure to care as well as improve technical procedural skill learning.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"140 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86657264","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}
Abhay Srinviasan, M. Acord, G. Lambert, S. Sierre, F. Escobar
Abstract This review provides a comprehensive summary of the role of the interventional radiologist in managing liver disorders in children. Interventions are discussed with focus on indications for procedure, technical aspects, and patient management. Recommendations are supported by the most recent evidence and practice experience of the authors in the four subtopics, such as interventions in the post–liver transplant setting, for portal hypertension, for liver tumors, and for vascular anomalies of the liver, with emphasis on congenital portosystemic shunts.
{"title":"Liver Interventions in Children","authors":"Abhay Srinviasan, M. Acord, G. Lambert, S. Sierre, F. Escobar","doi":"10.1055/s-0043-1771312","DOIUrl":"https://doi.org/10.1055/s-0043-1771312","url":null,"abstract":"Abstract This review provides a comprehensive summary of the role of the interventional radiologist in managing liver disorders in children. Interventions are discussed with focus on indications for procedure, technical aspects, and patient management. Recommendations are supported by the most recent evidence and practice experience of the authors in the four subtopics, such as interventions in the post–liver transplant setting, for portal hypertension, for liver tumors, and for vascular anomalies of the liver, with emphasis on congenital portosystemic shunts.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88487459","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}
K. Quencer, E. Gilbert, Leonardo Campos, Emily R. Jonica
Abstract Walled-off pancreatic necrosis is a potential sequela of necrotizing pancreatitis. When drainage is indicated, such as in the setting of local complications (biliary or bowel obstruction), superinfection, or the collection causing abdominal pain, endoscopic, percutaneous, and surgical approaches are possible. Endoscopic drainage with or without placement of a luminal apposing metal stent and possible direct endoscopic necrosectomy is the preferred approach for drainage given good outcomes and patient comfort. In some cases, due to location and/or lack of a mature wall, endoscopic drainage is not possible or may be ineffective. In such cases, percutaneous and/or surgical drainage may be necessary.
{"title":"Walled-off Pancreatic Necrosis: Multidisciplinary Perspective","authors":"K. Quencer, E. Gilbert, Leonardo Campos, Emily R. Jonica","doi":"10.1055/s-0043-1771306","DOIUrl":"https://doi.org/10.1055/s-0043-1771306","url":null,"abstract":"Abstract Walled-off pancreatic necrosis is a potential sequela of necrotizing pancreatitis. When drainage is indicated, such as in the setting of local complications (biliary or bowel obstruction), superinfection, or the collection causing abdominal pain, endoscopic, percutaneous, and surgical approaches are possible. Endoscopic drainage with or without placement of a luminal apposing metal stent and possible direct endoscopic necrosectomy is the preferred approach for drainage given good outcomes and patient comfort. In some cases, due to location and/or lack of a mature wall, endoscopic drainage is not possible or may be ineffective. In such cases, percutaneous and/or surgical drainage may be necessary.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83814235","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 Liver biopsy is important for staging of liver disease and cirrhosis and can be performed by many techniques. While percutaneous biopsy is fast, safe, effective, and widely available, transvenous biopsy, most often performed from the transjugular approach, offers many advantages for selected patients. In the setting of suspected or confirmed portal hypertension, transjugular liver biopsy (TJLB), most commonly performed by interventional radiologists, can be used to simultaneously obtain core biopsies of the liver and measure hemodynamic pressures in the right atrium, hepatic vein, and portal vein to calculate a hepatic venous pressure gradient. TJLB can be performed safely when percutaneous biopsy is contraindicated, including in the setting of ascites, coagulopathy, anticoagulation, and other high-risk bleeding situations. The procedure can be performed in the outpatient setting in a short period of time for most patients and without the use of precious anesthesia resources. Hepatic venography also allows for variant anatomy evaluation that may be important in the diagnosis and planning of future procedures, such as transjugular intrahepatic portosystemic shunt.
{"title":"Liver Biopsy and Pressure Hemodynamics: IR Perspective","authors":"Aakash Jain, Joseph A. Hughes III, S. Tavri","doi":"10.1055/s-0043-1771311","DOIUrl":"https://doi.org/10.1055/s-0043-1771311","url":null,"abstract":"Abstract Liver biopsy is important for staging of liver disease and cirrhosis and can be performed by many techniques. While percutaneous biopsy is fast, safe, effective, and widely available, transvenous biopsy, most often performed from the transjugular approach, offers many advantages for selected patients. In the setting of suspected or confirmed portal hypertension, transjugular liver biopsy (TJLB), most commonly performed by interventional radiologists, can be used to simultaneously obtain core biopsies of the liver and measure hemodynamic pressures in the right atrium, hepatic vein, and portal vein to calculate a hepatic venous pressure gradient. TJLB can be performed safely when percutaneous biopsy is contraindicated, including in the setting of ascites, coagulopathy, anticoagulation, and other high-risk bleeding situations. The procedure can be performed in the outpatient setting in a short period of time for most patients and without the use of precious anesthesia resources. Hepatic venography also allows for variant anatomy evaluation that may be important in the diagnosis and planning of future procedures, such as transjugular intrahepatic portosystemic shunt.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"18 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75924622","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 Gastric varices are a sequela of portal hypertension. If left untreated, life-threatening bleeding can occur. While endoscopic treatment is traditionally considered as a first-line interventional option, endovascular techniques have emerged to become the superior option in certain clinical scenarios, either as a first-line therapy or a salvage therapy. Endovascular techniques for managing gastric varices include transjugular intrahepatic portosystemic shunt (TIPS) placement, balloon-occluded retrograde transvenous obliteration (BRTO), coil, and plug-assisted retrograde transvenous obliteration, as well as a combination of both. Studies have shown that endovascular techniques can effectively control bleeding from gastric varices, with high success rates and low complication rates, and significantly reduce recurrence. TIPS placement has shown to be more effective in controlling bleeding from gastroesophageal varices, while BRTO, coil, or plug-assisted embolizations are more suitable for patients with isolated gastric varices. Endovascular interventions are a valuable option for managing gastric varices, especially in patients who are not candidates for endoscopic treatment or who have failed previous endoscopic interventions. In this two-part series editorial, we aim to initially review the complex anatomy and classification of gastric varices, medical management, and current endovascular interventional techniques, and how they compare with one another. In part 2, we draw a parallel between endovascular versus endoscopic techniques, and highlight and critically review current literature as it pertains to gastric variceal management.
{"title":"Management of Gastric Varices: IR Perspective","authors":"Mario Dervishi, C. Sutter, R. Varma","doi":"10.1055/s-0043-1771305","DOIUrl":"https://doi.org/10.1055/s-0043-1771305","url":null,"abstract":"Abstract Gastric varices are a sequela of portal hypertension. If left untreated, life-threatening bleeding can occur. While endoscopic treatment is traditionally considered as a first-line interventional option, endovascular techniques have emerged to become the superior option in certain clinical scenarios, either as a first-line therapy or a salvage therapy. Endovascular techniques for managing gastric varices include transjugular intrahepatic portosystemic shunt (TIPS) placement, balloon-occluded retrograde transvenous obliteration (BRTO), coil, and plug-assisted retrograde transvenous obliteration, as well as a combination of both. Studies have shown that endovascular techniques can effectively control bleeding from gastric varices, with high success rates and low complication rates, and significantly reduce recurrence. TIPS placement has shown to be more effective in controlling bleeding from gastroesophageal varices, while BRTO, coil, or plug-assisted embolizations are more suitable for patients with isolated gastric varices. Endovascular interventions are a valuable option for managing gastric varices, especially in patients who are not candidates for endoscopic treatment or who have failed previous endoscopic interventions. In this two-part series editorial, we aim to initially review the complex anatomy and classification of gastric varices, medical management, and current endovascular interventional techniques, and how they compare with one another. In part 2, we draw a parallel between endovascular versus endoscopic techniques, and highlight and critically review current literature as it pertains to gastric variceal management.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"110 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89323891","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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