F. Yuan, Eric D. Saunders, Julian McDonald, A. Balar, Jacob Pence, Chad K. Brady, Marshall Hutchison, Robert Grammer
Biliary stricture is the abnormal narrowing of the biliary ductal system, leading to bile stasis and eventual ductal obstruction and dilatation. Common etiologies of biliary strictures can be broadly classified based on benign or malignant causes. The pathogenesis of benign biliary strictures (BBSs) can be a sequela of several causes, including iatrogenic, inflammatory, ischemic, infectious, and immunologic etiologies. Among the common causes of BBS, an iatrogenic biliary ductal injury sustained during hepatobiliary surgeries is the most frequently reported cause of BBS. Clinically, patients with BBS can present with obstructive biliary symptoms, and urgent biliary decompressive interventions are frequently required to prevent fatal complications. Cross-sectional imaging such as MR cholangiopancreatography enables timely evaluation of the stricture and facilitates therapeutic planning. The primary objective in managing biliary strictures (both benign and malignant) is to achieve permanent ductal patency and minimize the need for repeated interventions. A multidisciplinary team of gastroenterologists, interventional radiologists, and hepatobiliary surgeons is generally involved in caring for patients with BBS. This review provides a summary of clinically available endoscopic, percutaneous, and surgical biliary interventions for the management of patients with BBS.
{"title":"Management Strategies for Benign Biliary Strictures","authors":"F. Yuan, Eric D. Saunders, Julian McDonald, A. Balar, Jacob Pence, Chad K. Brady, Marshall Hutchison, Robert Grammer","doi":"10.1055/s-0042-1755312","DOIUrl":"https://doi.org/10.1055/s-0042-1755312","url":null,"abstract":"Biliary stricture is the abnormal narrowing of the biliary ductal system, leading to bile stasis and eventual ductal obstruction and dilatation. Common etiologies of biliary strictures can be broadly classified based on benign or malignant causes. The pathogenesis of benign biliary strictures (BBSs) can be a sequela of several causes, including iatrogenic, inflammatory, ischemic, infectious, and immunologic etiologies. Among the common causes of BBS, an iatrogenic biliary ductal injury sustained during hepatobiliary surgeries is the most frequently reported cause of BBS. Clinically, patients with BBS can present with obstructive biliary symptoms, and urgent biliary decompressive interventions are frequently required to prevent fatal complications. Cross-sectional imaging such as MR cholangiopancreatography enables timely evaluation of the stricture and facilitates therapeutic planning. The primary objective in managing biliary strictures (both benign and malignant) is to achieve permanent ductal patency and minimize the need for repeated interventions. A multidisciplinary team of gastroenterologists, interventional radiologists, and hepatobiliary surgeons is generally involved in caring for patients with BBS. This review provides a summary of clinically available endoscopic, percutaneous, and surgical biliary interventions for the management of patients with BBS.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76414005","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}
Endoscopic ultrasound–guided biliary drainage (EUS-BD) procedures aid in the treatment of biliary diseases and can be considered in the setting of failed conventional endoscopic retrograde cholangiopancreatography, surgically altered gastrointestinal or biliary anatomy with an inaccessible major papilla, malignant obstruction precluding biliary access, or a contraindication to percutaneous biliary access. Although device innovations and technical improvements continue to advance the field of therapeutic EUS, further investigations are required. The purpose of this review is to highlight recent literature on the indications, techniques, capabilities, and outcomes of EUS-BD. Recent literature has demonstrated that EUS-BD is a safe and effective treatment option in the management of biliary diseases. Current studies have assessed the various EUS-BD techniques and have attempted to clarify the optimal treatment algorithm for those with complex biliary pathologies.
{"title":"Endoscopic Approaches to the Management of Biliary Tract Pathology: The Use of Therapeutic Endoscopic Ultrasound","authors":"Amy E. Hosmer","doi":"10.1055/s-0042-1749645","DOIUrl":"https://doi.org/10.1055/s-0042-1749645","url":null,"abstract":"Endoscopic ultrasound–guided biliary drainage (EUS-BD) procedures aid in the treatment of biliary diseases and can be considered in the setting of failed conventional endoscopic retrograde cholangiopancreatography, surgically altered gastrointestinal or biliary anatomy with an inaccessible major papilla, malignant obstruction precluding biliary access, or a contraindication to percutaneous biliary access. Although device innovations and technical improvements continue to advance the field of therapeutic EUS, further investigations are required. The purpose of this review is to highlight recent literature on the indications, techniques, capabilities, and outcomes of EUS-BD. Recent literature has demonstrated that EUS-BD is a safe and effective treatment option in the management of biliary diseases. Current studies have assessed the various EUS-BD techniques and have attempted to clarify the optimal treatment algorithm for those with complex biliary pathologies.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"21 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79645925","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 enteral access for nutritional support may be required for a wide host of comorbid conditions, including processes such as obstructive head and neck tumors, esophageal tumors, neurologic/neuromuscular disorders such as amyotrophic lateral sclerosis, multiple sclerosis, or stroke, chronic gastric outlet obstruction, small bowel obstruction, and motility disorders. Given this demand, it is important for providers to be aware of the complications associated with percutaneous radiologic enteral access and how to manage them. We herein provide a brief overview of complications related to enteral access, including anatomic, technical, preventative, and management considerations.
{"title":"Enteral Access: A Review of Technique, Complications, and Management Strategies","authors":"C. HonShideler, Bushra Manzar, M. Bader","doi":"10.1055/s-0043-1761633","DOIUrl":"https://doi.org/10.1055/s-0043-1761633","url":null,"abstract":"Abstract Percutaneous enteral access for nutritional support may be required for a wide host of comorbid conditions, including processes such as obstructive head and neck tumors, esophageal tumors, neurologic/neuromuscular disorders such as amyotrophic lateral sclerosis, multiple sclerosis, or stroke, chronic gastric outlet obstruction, small bowel obstruction, and motility disorders. Given this demand, it is important for providers to be aware of the complications associated with percutaneous radiologic enteral access and how to manage them. We herein provide a brief overview of complications related to enteral access, including anatomic, technical, preventative, and management considerations.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"84 1","pages":"095 - 102"},"PeriodicalIF":0.0,"publicationDate":"2022-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75405277","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}
J. Guan, S. Laroia, A. McBride, Shiliang Sun, Lihong Huang, J. Yang, Michael Dunlay, P. Nagpal
Abstract Finding a feeding vessel with diameter greater than 0.9 mm during transarterial chemoembolization (TACE) for hepatocellular cancer (HCC) has been shown to predict tumor necrosis on subsequent pathology. However, whether this translates into a useful clinical predictor for post-chemoembolization response and survival is unknown. This study aimed to determine whether the presence of an arterial feeder on pre-TACE cross-sectional imaging is associated with treatment response and survival after TACE for unresectable HCC. Retrospective medical record search for all chemo-embolizations performed for HCC from 2015 to 2016 yielded 138 patients who underwent 275 TACE sessions spanning 2011 to 2017. Patients consisted of 98 males (71%) with mean age of 62 (range, 37–86). Each patient underwent an average of two TACE sessions (range, 1–11). Endpoints included target tumor response and overall response defined by the mRECIST criteria, as well as patient survival. Preprocedural MRI/CT was reviewed for the presence of arterial feeder. Multivariable logistic regressions and Cox proportional hazard regressions were used to assess the effects of arterial feeder presence on treatment response and survival, respectively, adjusting for other covariates. Overall response was seen in 69% of patients. Arterial feeder was present on preprocedural cross-sectional imaging for 28% of TACE sessions. Median survival was 26.5 months (interquartile range, 13.2–38.1). The presence of arterial feeder led to better target tumor response (OR = 11.9, p < 0.0001), overall response (OR = 9.3, p < 0.0001), and improved survival (HR = 0.55, p = 0.02). The presence of an arterial feeder on pre-TACE cross-sectional imaging is associated with target tumor response, overall response, and survival after TACE.
在肝细胞癌(HCC)的经动脉化疗栓塞(TACE)中寻找直径大于0.9 mm的供血血管已被证明可以预测随后的病理肿瘤坏死。然而，这是否转化为化疗后栓塞反应和生存的有用临床预测指标尚不清楚。本研究旨在确定在TACE前的横断面成像中动脉喂养器的存在是否与不可切除的HCC TACE后的治疗反应和生存有关。对2015年至2016年所有肝癌化疗栓塞的回顾性医疗记录进行搜索，发现138例患者在2011年至2017年期间接受了275次TACE治疗。患者包括98名男性(71%)，平均年龄62岁(范围37-86岁)。每位患者平均接受两次TACE治疗(范围1-11)。终点包括靶肿瘤反应和mRECIST标准定义的总反应，以及患者生存。术前复查MRI/CT检查有无动脉馈线。采用多变量logistic回归和Cox比例风险回归分别评估动脉喂食器存在对治疗反应和生存的影响，并对其他协变量进行调整。69%的患者出现总体缓解。28%的TACE疗程在术前横断面成像上出现动脉喂食器。中位生存期为26.5个月(四分位数间距为13.2-38.1)。动脉喂食器的存在导致更好的靶肿瘤反应(OR = 11.9, p < 0.0001)，总体反应(OR = 9.3, p < 0.0001)和生存率的提高(HR = 0.55, p = 0.02)。在TACE前的横断面成像中动脉喂养器的存在与靶肿瘤反应、总体反应和TACE后的生存有关。
{"title":"Presence of an Arterial Feeding Vessel on Cross-Sectional Imaging Predicts Treatment Response and Survival after Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma: A Retrospective Multivariable Analysis of 138 Patients","authors":"J. Guan, S. Laroia, A. McBride, Shiliang Sun, Lihong Huang, J. Yang, Michael Dunlay, P. Nagpal","doi":"10.1055/s-0043-1760728","DOIUrl":"https://doi.org/10.1055/s-0043-1760728","url":null,"abstract":"Abstract Finding a feeding vessel with diameter greater than 0.9 mm during transarterial chemoembolization (TACE) for hepatocellular cancer (HCC) has been shown to predict tumor necrosis on subsequent pathology. However, whether this translates into a useful clinical predictor for post-chemoembolization response and survival is unknown. This study aimed to determine whether the presence of an arterial feeder on pre-TACE cross-sectional imaging is associated with treatment response and survival after TACE for unresectable HCC. Retrospective medical record search for all chemo-embolizations performed for HCC from 2015 to 2016 yielded 138 patients who underwent 275 TACE sessions spanning 2011 to 2017. Patients consisted of 98 males (71%) with mean age of 62 (range, 37–86). Each patient underwent an average of two TACE sessions (range, 1–11). Endpoints included target tumor response and overall response defined by the mRECIST criteria, as well as patient survival. Preprocedural MRI/CT was reviewed for the presence of arterial feeder. Multivariable logistic regressions and Cox proportional hazard regressions were used to assess the effects of arterial feeder presence on treatment response and survival, respectively, adjusting for other covariates. Overall response was seen in 69% of patients. Arterial feeder was present on preprocedural cross-sectional imaging for 28% of TACE sessions. Median survival was 26.5 months (interquartile range, 13.2–38.1). The presence of arterial feeder led to better target tumor response (OR = 11.9, p < 0.0001), overall response (OR = 9.3, p < 0.0001), and improved survival (HR = 0.55, p = 0.02). The presence of an arterial feeder on pre-TACE cross-sectional imaging is associated with target tumor response, overall response, and survival after TACE.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"14 1","pages":"169 - 179"},"PeriodicalIF":0.0,"publicationDate":"2022-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82898520","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}
Biliary leaks and bilomas are significant complications that arise more commonly from iatrogenic or traumatic bile duct injury. These are increasingly occurring primarily due to the growing number of laparoscopic cholecystectomies performed. Diagnosis can be challenging because of nonspecific patient symptoms, but early recognition and treatment is crucial for improving patient outcomes. Detection of biliary leaks involves a strong clinical suspicion and multimodal imaging studies, including magnetic resonance cholangiopancreatography, cholescintigraphy, endoscopic retrograde cholangiopancreatography, or percutaneous transhepatic cholangiography. Definitive treatment most often requires the endoscopic placement of biliary stents to decrease pressure in the biliary system and the placement of a percutaneous drain for drainage if a biloma is found. However, biliary leaks are heterogeneous in their severity and location, and some are refractory to the standard approach. In such cases, novel and minimally invasive techniques, rather than surgical procedures, have been described for the treatment of biliary leaks. Diagnosis and management require a multidisciplinary approach by diagnostic radiologists, interventional radiologists, gastroenterologists, and surgeons.
{"title":"Biliary Leaks and Bilomas: Etiology, Diagnosis, and Management Techniques","authors":"Prateek C. Gowda, C. Georgiades, C. Weiss","doi":"10.1055/s-0042-1753462","DOIUrl":"https://doi.org/10.1055/s-0042-1753462","url":null,"abstract":"Biliary leaks and bilomas are significant complications that arise more commonly from iatrogenic or traumatic bile duct injury. These are increasingly occurring primarily due to the growing number of laparoscopic cholecystectomies performed. Diagnosis can be challenging because of nonspecific patient symptoms, but early recognition and treatment is crucial for improving patient outcomes. Detection of biliary leaks involves a strong clinical suspicion and multimodal imaging studies, including magnetic resonance cholangiopancreatography, cholescintigraphy, endoscopic retrograde cholangiopancreatography, or percutaneous transhepatic cholangiography. Definitive treatment most often requires the endoscopic placement of biliary stents to decrease pressure in the biliary system and the placement of a percutaneous drain for drainage if a biloma is found. However, biliary leaks are heterogeneous in their severity and location, and some are refractory to the standard approach. In such cases, novel and minimally invasive techniques, rather than surgical procedures, have been described for the treatment of biliary leaks. Diagnosis and management require a multidisciplinary approach by diagnostic radiologists, interventional radiologists, gastroenterologists, and surgeons.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82187844","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 remains a challenge both in terms of diagnosis and treatment. Due to the lack of a useful screening test and often clinically silent early course, disease stage is often advanced at the time of diagnosis. Surgical resection remains the only potentially curative treatment option and recurrence rates are high; however, liver transplantation has recently resulted in promising outcomes in certain groups of patients with intrahepatic and perihilar cholangiocarcinoma. For patients in whom surgery is not an option, chemotherapy with gemcitabine and cisplatin is the first-line treatment. An array of locoregional management options exists, which includes transarterial embolization, hepatic arterial chemotherapy infusion, ablation, and radiation therapy. High-quality data from randomized controlled trials for these treatments remains limited, however, and additional study is needed.
{"title":"Update on Cholangiocarcinoma","authors":"D. Irwin","doi":"10.1055/s-0042-1751238","DOIUrl":"https://doi.org/10.1055/s-0042-1751238","url":null,"abstract":"Cholangiocarcinoma remains a challenge both in terms of diagnosis and treatment. Due to the lack of a useful screening test and often clinically silent early course, disease stage is often advanced at the time of diagnosis. Surgical resection remains the only potentially curative treatment option and recurrence rates are high; however, liver transplantation has recently resulted in promising outcomes in certain groups of patients with intrahepatic and perihilar cholangiocarcinoma. For patients in whom surgery is not an option, chemotherapy with gemcitabine and cisplatin is the first-line treatment. An array of locoregional management options exists, which includes transarterial embolization, hepatic arterial chemotherapy infusion, ablation, and radiation therapy. High-quality data from randomized controlled trials for these treatments remains limited, however, and additional study is needed.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86351029","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 Transcatheter embolization is an effective minimally invasive treatment for nonvariceal gastrointestinal (GI) hemorrhage. While many patients with GI bleeding can be treated endoscopically, transcatheter embolization is an important therapy in patients with bleeding refractory to endoscopic management and serves as an alternative to surgery. Despite having lower morbidity than surgical management of GI bleeding, transcatheter embolization has its own set of risks and complications. Moreover, embolization can be performed with a variety of embolic agents, each with their own advantages and disadvantages. Knowledge of complications specific to transcatheter embolization is essential for interventional radiologists as well as all physicians involved in managing patients with GI hemorrhage.
{"title":"Complications of Arterial Transcatheter Embolization for Treatment of Gastrointestinal Hemorrhage","authors":"W. Lindquester","doi":"10.1055/s-0042-1760427","DOIUrl":"https://doi.org/10.1055/s-0042-1760427","url":null,"abstract":"Abstract Transcatheter embolization is an effective minimally invasive treatment for nonvariceal gastrointestinal (GI) hemorrhage. While many patients with GI bleeding can be treated endoscopically, transcatheter embolization is an important therapy in patients with bleeding refractory to endoscopic management and serves as an alternative to surgery. Despite having lower morbidity than surgical management of GI bleeding, transcatheter embolization has its own set of risks and complications. Moreover, embolization can be performed with a variety of embolic agents, each with their own advantages and disadvantages. Knowledge of complications specific to transcatheter embolization is essential for interventional radiologists as well as all physicians involved in managing patients with GI hemorrhage.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"1 1","pages":"089 - 094"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83049805","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 expansion of colorectal cancer screening programs predicts a remarkable increase in rectal cancer diagnosis and nonmalignant polyps. While most polyps are managed endoscopically, many patients are referred to surgery. Over 30 thousand patients with colon polyps undergo surgical resection annually in the United States. Most of these surgical resections typically report benign pathology but end up with organ loss. Such organ resections may enclose significant morbidity and mortality rates. On the other hand, advanced endoscopic interventions have significantly evolved and are gaining popularity due to claiming organ preservation with low morbidity and mortality. These procedures have the potential to develop further and, in no doubt, are becoming standard of care. There are recent articles reporting successful and feasible initial incorporation of robotic systems for submucosal dissection procedures. These developments confirm that endorobotic submucosal dissection and endorobotic surgery may soon become a reality for colorectal lesions. This article aims to discuss endoluminal surgery for colorectal lesions and future directions.
{"title":"Endoluminal Surgery and Next Steps","authors":"I. Ozgur, E. Gorgun","doi":"10.1055/s-0043-1760732","DOIUrl":"https://doi.org/10.1055/s-0043-1760732","url":null,"abstract":"Abstract The expansion of colorectal cancer screening programs predicts a remarkable increase in rectal cancer diagnosis and nonmalignant polyps. While most polyps are managed endoscopically, many patients are referred to surgery. Over 30 thousand patients with colon polyps undergo surgical resection annually in the United States. Most of these surgical resections typically report benign pathology but end up with organ loss. Such organ resections may enclose significant morbidity and mortality rates. On the other hand, advanced endoscopic interventions have significantly evolved and are gaining popularity due to claiming organ preservation with low morbidity and mortality. These procedures have the potential to develop further and, in no doubt, are becoming standard of care. There are recent articles reporting successful and feasible initial incorporation of robotic systems for submucosal dissection procedures. These developments confirm that endorobotic submucosal dissection and endorobotic surgery may soon become a reality for colorectal lesions. This article aims to discuss endoluminal surgery for colorectal lesions and future directions.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"48 1","pages":"010 - 016"},"PeriodicalIF":0.0,"publicationDate":"2022-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77155463","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}
Fiza M. Khan, N. Nezami, Florian Stumpf, T. Smith, Margarita Revizin, A. Fang, Mohammad Loya, R. Sheth, S. Yevich, Peiman Habibillahi
Abstract As access to affordable high-resolution medical imaging has improved, so too has the identification of benign hepatic lesions. Advanced imaging techniques and applications often allow characterization of these lesions so as to differentiate benign and malignant lesions without the need for biopsy. Patients with benign liver lesions are usually asymptomatic; however, a palliative intervention may be indicated if a benign liver lesion is symptomatic. This article reviews the characteristic imaging features of benign liver lesions, the indications for minimally invasive intervention, and the specific procedures for minimally invasive, nonsurgical intervention, and the procedural expectations, effectiveness, and periprocedural care.
{"title":"Minimally Invasive Image-Guided Procedures for Benign Liver Lesions","authors":"Fiza M. Khan, N. Nezami, Florian Stumpf, T. Smith, Margarita Revizin, A. Fang, Mohammad Loya, R. Sheth, S. Yevich, Peiman Habibillahi","doi":"10.1055/s-0043-1762923","DOIUrl":"https://doi.org/10.1055/s-0043-1762923","url":null,"abstract":"Abstract As access to affordable high-resolution medical imaging has improved, so too has the identification of benign hepatic lesions. Advanced imaging techniques and applications often allow characterization of these lesions so as to differentiate benign and malignant lesions without the need for biopsy. Patients with benign liver lesions are usually asymptomatic; however, a palliative intervention may be indicated if a benign liver lesion is symptomatic. This article reviews the characteristic imaging features of benign liver lesions, the indications for minimally invasive intervention, and the specific procedures for minimally invasive, nonsurgical intervention, and the procedural expectations, effectiveness, and periprocedural care.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"120 1","pages":"202 - 222"},"PeriodicalIF":0.0,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73365839","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 majority of patients with cholangiocarcinoma and malignant biliary obstruction cannot undergo surgery for treatment as they present late in the disease course. It is crucial to relieve biliary obstruction in these conditions, for which metallic stents are commonly used. However, these stents have a high rate of occlusion due to the ingrowth of malignant tissue. In this review, we will discuss the use of direct endobiliary therapies that can be used either independently or in combination with metallic stents.
{"title":"A Review of Direct Endobiliary Techniques for the Management of Biliary Conditions","authors":"T. Garg, H. Singh, C. Weiss","doi":"10.1055/s-0042-1749383","DOIUrl":"https://doi.org/10.1055/s-0042-1749383","url":null,"abstract":"A majority of patients with cholangiocarcinoma and malignant biliary obstruction cannot undergo surgery for treatment as they present late in the disease course. It is crucial to relieve biliary obstruction in these conditions, for which metallic stents are commonly used. However, these stents have a high rate of occlusion due to the ingrowth of malignant tissue. In this review, we will discuss the use of direct endobiliary therapies that can be used either independently or in combination with metallic stents.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90655858","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：