Acute mesenteric ischemia (AMI) is a dreaded, highly morbid pathology. Often this is due to acute occlusion of the superior mesenteric artery. This can be from thrombus or embolism; however, AMI can also be the result of mesenteric venous thrombus or nonocclusive mesenteric ischemia. There have been many recent advances in diagnosis and treatment including endovascular therapies. While there is increasing data to support an endovascular first approach, with improved 30-day mortality rates and in-hospital mortality, many patients will still require surgical intervention at some point. This article will review AMI for the interventional radiologist including etiologies, diagnosis, and management.
{"title":"Acute Mesenteric Ischemia: Evaluation, Management, and Interventions","authors":"C. Kaufman","doi":"10.1055/s-0042-1757764","DOIUrl":"https://doi.org/10.1055/s-0042-1757764","url":null,"abstract":"Acute mesenteric ischemia (AMI) is a dreaded, highly morbid pathology. Often this is due to acute occlusion of the superior mesenteric artery. This can be from thrombus or embolism; however, AMI can also be the result of mesenteric venous thrombus or nonocclusive mesenteric ischemia. There have been many recent advances in diagnosis and treatment including endovascular therapies. While there is increasing data to support an endovascular first approach, with improved 30-day mortality rates and in-hospital mortality, many patients will still require surgical intervention at some point. This article will review AMI for the interventional radiologist including etiologies, diagnosis, and management.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"14 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72410422","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 Percutaneous management of complications of portal hypertension entails reducing portal pressures, controlling varices, and redirecting collateral flow using embolization, obliterative, restorative, recanalization, and shunt creation techniques. Management is based on the clinical status and symptoms and the physiologic and anatomic abnormalities causing portal hypertension. This article briefly describes percutaneous management strategies, their results, and related iatrogenic and physiologic complications.
{"title":"Portal Vein Interventions for Portal Hypertension: Complications and Management","authors":"P. Novelli, Jason Polder, C. Kaufman, P. Orons","doi":"10.1055/s-0043-1761634","DOIUrl":"https://doi.org/10.1055/s-0043-1761634","url":null,"abstract":"Abstract Percutaneous management of complications of portal hypertension entails reducing portal pressures, controlling varices, and redirecting collateral flow using embolization, obliterative, restorative, recanalization, and shunt creation techniques. Management is based on the clinical status and symptoms and the physiologic and anatomic abnormalities causing portal hypertension. This article briefly describes percutaneous management strategies, their results, and related iatrogenic and physiologic complications.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"41 1","pages":"081 - 088"},"PeriodicalIF":0.0,"publicationDate":"2022-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75241826","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 Iatrogenic complications can result from both diagnostic and therapeutic hepatobiliary interventions such as percutaneous transhepatic cholangiography, percutaneous biliary drain placement, percutaneous liver biopsy, transarterial liver-directed therapies for malignancy, and liver transplantation. In many of these procedures, the proximity of the biliary ductal system to the hepatic arteries and portal veins predisposes to injury. In other procedures, compromised arterial supply to the biliary system, errors related to complexity of the procedures, or the fragility of the structures themselves may be the root cause. Understanding the etiology of these iatrogenic complications as well as the management options is essential for a multidisciplinary team tasked with managing patients with complex hepatobiliary diseases.
{"title":"Iatrogenic Complications and Management of Biliary Interventions","authors":"S. Martens, K. Karani, R. Navuluri","doi":"10.1055/s-0043-1763291","DOIUrl":"https://doi.org/10.1055/s-0043-1763291","url":null,"abstract":"Abstract Iatrogenic complications can result from both diagnostic and therapeutic hepatobiliary interventions such as percutaneous transhepatic cholangiography, percutaneous biliary drain placement, percutaneous liver biopsy, transarterial liver-directed therapies for malignancy, and liver transplantation. In many of these procedures, the proximity of the biliary ductal system to the hepatic arteries and portal veins predisposes to injury. In other procedures, compromised arterial supply to the biliary system, errors related to complexity of the procedures, or the fragility of the structures themselves may be the root cause. Understanding the etiology of these iatrogenic complications as well as the management options is essential for a multidisciplinary team tasked with managing patients with complex hepatobiliary diseases.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"523 1","pages":"110 - 117"},"PeriodicalIF":0.0,"publicationDate":"2022-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78154309","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}
Chronic visceral abdominal pain due to malignant and inflammatory conditions can be challenging to treat, requiring a multidisciplinary approach. Opiates are commonly employed in the palliation of chronic abdominal pain but are complicated by quality of life-limiting side effects such as nausea, vomiting, sedation, and constipation. Celiac plexus block and neurolysis (CPBN) are important tools in the multimodality approach to such pain, with documented improvement in pain scores and, importantly, reduction in opiate demands and improvement in quality of life. It targets the celiac relay station that mediates transmission of visceral nociceptive information from upper abdominal organs; distinguishing from somatic and neuropathic pain is important for clinical success. Key determinants of procedure success include patient selection, understanding relevant anatomy, how that anatomy is distorted by pathology, selection of location for block or neurolysis, as well as distribution and volume administered of injectate during the procedure. CPBN is a safe procedure associated with a low complication rate and may demonstrate better efficacy when used earlier in a patient's disease course.
{"title":"CT-Guided Celiac Plexus Block and Neurolysis for Chronic Upper Abdominal Pain","authors":"Ashraf Thabet","doi":"10.1055/s-0042-1750414","DOIUrl":"https://doi.org/10.1055/s-0042-1750414","url":null,"abstract":"Chronic visceral abdominal pain due to malignant and inflammatory conditions can be challenging to treat, requiring a multidisciplinary approach. Opiates are commonly employed in the palliation of chronic abdominal pain but are complicated by quality of life-limiting side effects such as nausea, vomiting, sedation, and constipation. Celiac plexus block and neurolysis (CPBN) are important tools in the multimodality approach to such pain, with documented improvement in pain scores and, importantly, reduction in opiate demands and improvement in quality of life. It targets the celiac relay station that mediates transmission of visceral nociceptive information from upper abdominal organs; distinguishing from somatic and neuropathic pain is important for clinical success. Key determinants of procedure success include patient selection, understanding relevant anatomy, how that anatomy is distorted by pathology, selection of location for block or neurolysis, as well as distribution and volume administered of injectate during the procedure. CPBN is a safe procedure associated with a low complication rate and may demonstrate better efficacy when used earlier in a patient's disease course.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79443024","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}
Splenic artery embolization has become an important tool in the management of splenic trauma. This review discusses the indications, anatomy, devices, techniques, and complications associated with splenic artery embolization.
{"title":"Splenic Trauma: Technical Considerations and Management of Complications","authors":"Marc Michael Del Rosario Lim, K. Farsad","doi":"10.1055/s-0042-1755315","DOIUrl":"https://doi.org/10.1055/s-0042-1755315","url":null,"abstract":"Splenic artery embolization has become an important tool in the management of splenic trauma. This review discusses the indications, anatomy, devices, techniques, and complications associated with splenic artery embolization.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90616619","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 Treatment of locally advanced rectal cancer remains one of the most challenging in colorectal surgery. It has had an evolving landscape over the past three decades. This review describes the introduction of total neoadjuvant therapy—a term aimed to describe an approach where both systemic chemotherapy and chemoradiation are administered in the preoperative setting. This novel strategy has come to the fore with the strength of well-documented results of recent trials. Its implementation has begun globally, but long-term outcomes and data analysis to identify optimal schedules are eagerly awaited.
{"title":"Neoadjuvant Treatment for Rectal Cancer and Nonoperative Management/Total Neoadjuvant Therapy","authors":"Amy Edwards-Murphy, P. Neary","doi":"10.1055/s-0042-1760371","DOIUrl":"https://doi.org/10.1055/s-0042-1760371","url":null,"abstract":"Abstract Treatment of locally advanced rectal cancer remains one of the most challenging in colorectal surgery. It has had an evolving landscape over the past three decades. This review describes the introduction of total neoadjuvant therapy—a term aimed to describe an approach where both systemic chemotherapy and chemoradiation are administered in the preoperative setting. This novel strategy has come to the fore with the strength of well-documented results of recent trials. Its implementation has begun globally, but long-term outcomes and data analysis to identify optimal schedules are eagerly awaited.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"9 1","pages":"030 - 036"},"PeriodicalIF":0.0,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90150857","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}
Emilio Sanín, J. Lopera, A. D. de Assis, José Andrade de Carvalho Melo Júnior, S. Alvarez
Abstract Gastric varices (GV) are a relatively uncommon cause of bleeding in the gastrointestinal tract. Compared with esophageal varices (EV), GV have been less well studied and therefore there is less consensus on the best treatment alternative. GV have distinct hemodynamic and anatomic considerations which must be well understood to provide adequate treatments. The purpose of this review is to describe the endovascular treatment options available: transjugular intrahepatic portosystemic shunt and balloon-occluded retrograde transvenous obliteration (BRTO) and its variants. Each of these alternatives has its indications for different clinical scenarios. Both are effective in controlling acute bleeding, but BRTO seems to have better long-term results. A detailed description of indications, techniques, complications, and results is included.
{"title":"Interventions in Gastric Varices: TIPS versus BRTO","authors":"Emilio Sanín, J. Lopera, A. D. de Assis, José Andrade de Carvalho Melo Júnior, S. Alvarez","doi":"10.1055/s-0043-1772853","DOIUrl":"https://doi.org/10.1055/s-0043-1772853","url":null,"abstract":"Abstract Gastric varices (GV) are a relatively uncommon cause of bleeding in the gastrointestinal tract. Compared with esophageal varices (EV), GV have been less well studied and therefore there is less consensus on the best treatment alternative. GV have distinct hemodynamic and anatomic considerations which must be well understood to provide adequate treatments. The purpose of this review is to describe the endovascular treatment options available: transjugular intrahepatic portosystemic shunt and balloon-occluded retrograde transvenous obliteration (BRTO) and its variants. Each of these alternatives has its indications for different clinical scenarios. Both are effective in controlling acute bleeding, but BRTO seems to have better long-term results. A detailed description of indications, techniques, complications, and results is included.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82764750","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 last decades have seen a remarkable improvement in colorectal surgery, as new techniques and protocols have been developed and adopted. Restoring the continuity of the intestinal tract after low rectal surgery remains one unresolved challenge. The development of new transanal techniques to approach the lowest rectum paved the way for a switch in mentality. Transanal total mesorectal excision has seen a steep adoption by colorectal surgeons, combining the transanal pathway with the use of minimally invasive techniques to overcome the historical difficulties of the anterior approach. One step ahead in the evolution of the transanal approach could be represented by the recently described transanal transection with single stapled technique, developed to address the main concerns of previous transanal approaches thus providing oncological and functional balance.
{"title":"From Transanal Total Mesorectal Excision to Transanal Transection with Single-Stapled: Evolution of Transanal Techniques","authors":"J. Crippa, C. Foppa, A. Spinelli","doi":"10.1055/s-0042-1760370","DOIUrl":"https://doi.org/10.1055/s-0042-1760370","url":null,"abstract":"Abstract The last decades have seen a remarkable improvement in colorectal surgery, as new techniques and protocols have been developed and adopted. Restoring the continuity of the intestinal tract after low rectal surgery remains one unresolved challenge. The development of new transanal techniques to approach the lowest rectum paved the way for a switch in mentality. Transanal total mesorectal excision has seen a steep adoption by colorectal surgeons, combining the transanal pathway with the use of minimally invasive techniques to overcome the historical difficulties of the anterior approach. One step ahead in the evolution of the transanal approach could be represented by the recently described transanal transection with single stapled technique, developed to address the main concerns of previous transanal approaches thus providing oncological and functional balance.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"68 1","pages":"037 - 041"},"PeriodicalIF":0.0,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73262180","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":"Radiologic and Endoscopic Approaches to Management of Biliary Tract Pathology","authors":"Charles Kim, A. Faulx","doi":"10.1055/s-0042-1755533","DOIUrl":"https://doi.org/10.1055/s-0042-1755533","url":null,"abstract":"","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"102 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88994529","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}
A. Askari, Egemen Tezcan, K. Patel, Md Tanveer Adil, A. Munasinghe, O. Al-Taan, V. Jain, P. Jambulingam, F. Rashid
Introduction Gastric volvulus is a rare yet life-threatening condition requiring urgent attention. In this case series and literature review, we present the difficulties in management and outcome in patients with gastric volvulus and suggest a tiered framework to guide management. All consecutive cases at a single institution presenting between January 1, 2010, and June 30, 2020, were included. Chi-squared analyses were undertaken to compare outcomes across different groups. A total of 48 patients presented with gastric volvulus; the median age was 78 years (interquartile range [IQR]: 69–84) and 70.8% were female. Most patients had an ASA score of III (n = 19/48, 39.6%) or IV (n = 14/48, 29.2%). In total, 62.5% (n = 30/48) underwent laparoscopic surgery and mesh was used in 40.0%. Eighteen patients (37.5%) were not suitable candidates for surgery or declined surgery. The median length of stay in those undergoing surgery was 4 days (IQR: 2–6). The complication rate in this cohort was 26.7% (n = 8/30). Of these eight patients, four had postoperative nausea, and four others suffered from pneumothorax, wound hematoma, intra-abdominal bleeding, or intra-abdominal collection. The patient who had a serious intra-abdominal bleed returned to operating room and required blood transfusions on day 1 postsurgery. The readmission rate in the surgery group was 6.6% (n = 2/30), both of who had prolonged nausea and were treated symptomatically. The overall 30-day morality in the surgical group was 3.3%. Over a follow-up period of 37 months, 10.0% had a recurrence of hernia, all of who were managed conservatively. Gastric volvulus is a surgical emergency that is associated with a high rate of morbidity and mortality. A tiered treatment algorithm based on urgency can help deliver timely treatment and standardize care. One in 10 patients post–gastric volvulus repair will have recurrence of para-oesophageal hernia but can be treated conservatively.
{"title":"Management and Outcomes in Gastric Volvulus: A Tiered Approach","authors":"A. Askari, Egemen Tezcan, K. Patel, Md Tanveer Adil, A. Munasinghe, O. Al-Taan, V. Jain, P. Jambulingam, F. Rashid","doi":"10.1055/s-0042-1750048","DOIUrl":"https://doi.org/10.1055/s-0042-1750048","url":null,"abstract":"\u0000 Introduction Gastric volvulus is a rare yet life-threatening condition requiring urgent attention. In this case series and literature review, we present the difficulties in management and outcome in patients with gastric volvulus and suggest a tiered framework to guide management. All consecutive cases at a single institution presenting between January 1, 2010, and June 30, 2020, were included. Chi-squared analyses were undertaken to compare outcomes across different groups. A total of 48 patients presented with gastric volvulus; the median age was 78 years (interquartile range [IQR]: 69–84) and 70.8% were female. Most patients had an ASA score of III (n = 19/48, 39.6%) or IV (n = 14/48, 29.2%). In total, 62.5% (n = 30/48) underwent laparoscopic surgery and mesh was used in 40.0%. Eighteen patients (37.5%) were not suitable candidates for surgery or declined surgery. The median length of stay in those undergoing surgery was 4 days (IQR: 2–6). The complication rate in this cohort was 26.7% (n = 8/30). Of these eight patients, four had postoperative nausea, and four others suffered from pneumothorax, wound hematoma, intra-abdominal bleeding, or intra-abdominal collection. The patient who had a serious intra-abdominal bleed returned to operating room and required blood transfusions on day 1 postsurgery. The readmission rate in the surgery group was 6.6% (n = 2/30), both of who had prolonged nausea and were treated symptomatically. The overall 30-day morality in the surgical group was 3.3%. Over a follow-up period of 37 months, 10.0% had a recurrence of hernia, all of who were managed conservatively. Gastric volvulus is a surgical emergency that is associated with a high rate of morbidity and mortality. A tiered treatment algorithm based on urgency can help deliver timely treatment and standardize care. One in 10 patients post–gastric volvulus repair will have recurrence of para-oesophageal hernia but can be treated conservatively.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87621839","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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