International Journal of Gastrointestinal Intervention

pISSN 2636-0004 eISSN 2636-0012

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< Previous Next >Int J Gastrointest Interv 2019; 8(2): 63~103

Review Article 2019-04-30

Embolization of procedure-related upper gastrointestinal bleeding

Yasir Nouri, Ji Hoon Shin , Heung-Kyu Ko, Jong Woo Kim, Hyun-Ki Yoon

https://doi.org/10.18528/ijgii170028

Abstract : Non-surgical procedure-related, upper gastrointestinal bleeding (UGIB) is considered as one of the rarest of all UGIB causes, although it is a serious complication when it occurs. It presented as hematemesis, melena or hemobilia in which is associated with hepatobiliary intervention. In most patients the bleeding resolves spontaneously and in those in which it does not, the majority respond to conservative management. Endoscopy is the first line of treatment if bleeding does not stop after medical management, although if it failed due to massive bleeding, in hemodynamically unstable patients or in hepatobiliary procedure-related bleeding, endovascular or surgical intervention should be considered. In this manuscript we will discuss the endovascular diagnosis and treatment of non-surgical procedure-related UGIB.

Cited By: 2

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Original Article 2019-04-30

Factors affecting outpatient bowel preparation for colonoscopy

Saloni A. Shah , Elinor Zhou, Neil D. Parikh

https://doi.org/10.18528/ijgii180039

Abstract : Background Colonoscopy remains one of the most effective methods to screen for colorectal cancer. However, the detection of colorectal polyps is dependent on the cleanliness of the colonic tract. The purpose of our retrospective chart review was to identify clinical factors that were associated with a lower Boston Bowel Preparation Scale (BBPS). Knowledge of these factors could identify which patients may benefit from increased pre-procedure guidance or more rigorous bowel preparation. Methods The charts of consecutive patients undergoing screening or surveillance colonoscopies over a one-year period were reviewed. Cases were defined as BBPS ≤ 5 while controls were patients with BBPS ≥ 6. For each included patient, multiple characteristics were extracted. The chi-square analysis was performed for univariate analysis and a binomial logistic regression model for the multivariable analysis. Results One thousand and fifty-five colonoscopy reports with BBPS scores were retrieved with 189 cases (BBPS ≤ 5) and 866 controls (BBPS ≥ 6). Cases and controls were similar in age, sex, ethnicity, employment status, and marital status. Compared to patients with adequate bowel preparations, significantly more patients with inadequate bowel preparation had the following characteristics: diabetes, psychiatric illness, American Society of Anesthesiologists class ≥ 3, history of inadequate bowel preparation, active smoker, opioid user, insulin user and Medicaid coverage. On multivariable logistic regression analyses, predictive factors of an inadequate bowel preparation were diabetes, psychiatric illness, opioid use, active tobacco use, history of inadequate bowel preparation, and Medicaid coverage. Conclusion This large retrospective case-control study identified independent predictive factors of an inadequate bowel preparation. Knowledge of these characteristics may aid both primary care providers and gastroenterologists in identifying patients who could benefit from an extended bowel preparation as well as enhanced education prior to their colonoscopy.

Cited By: 1

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Original Article 2019-04-30

Budd-Chiari syndrome managed with percutaneous recanalization: Long-term outcome and comparison with medical therapy

Chinmay Bhimaji Kulkarni , Srikanth Moorthy, Sreekumar Karumathil Pullara, Nirmal Kumar Prabhu, Ramiah Rajesh Kannan, Puthukudiyil Kader Nazar

https://doi.org/10.18528/ijgii180001

Abstract : Background To compare the outcomes in a group of patients with Budd-Chiari syndrome (BCS) managed by percutaneous recanalization with a group of patients who were managed by medical therapy alone. Methods We retrieved the hospital records of 37 patients with BCS admitted to our facility between 2004 to 2017 and identified 24 patients (male:female = 10:14; mean age, 32.7 ± 12.5 years) who underwent percutaneous recanalization. Remaining thirteen patients (male:female = 3:10; mean age, 36.77 ± 14.71 years), were managed by medical therapy. Technical and clinical results, complications, and primary patency of percutaneous recanalization were analyzed. Overall and symptom-free survival rates, the frequency of symptom recurrence, and the number of readmissions for recurrent symptoms were analyzed in both interventional treatment and medical therapy groups. Results Technical success for recanalization of hepatic vein/inferior venecava by angioplasty ± stenting was achieved in 22 patients (22/24, 91.7%). Clinical success was achieved in 19 patients (19/24, 79.2%). Overall survival for patients who underwent percutaneous recanalization at 1 year and five years was 87.0% and 87.0% and for patients with medical therapy was 90.1% and 45.5%, respectively (P = 0.710). Symptom-free survival for patients who underwent percutaneous recanalization at 1 year and five year was 93.3% and 81.7% and for patients with medical therapy was 26.0% and 0%, respectively (P < 0.001). In the intervention group, 4 patients (4/24, 16.7%) were admitted for recurrent symptoms (median number of readmissions 1, range: 1–2) whereas in medically managed patients 9 patients (9/13, 69.2%) were readmitted (median number of readmissions, 2; range, 1–5) (P = 0.003). Conclusion There was no statistically significant difference in overall survival of patients managed with percutaneous recanalization and medical therapy. Percutaneous recanalization had definite benefit in terms of fewer recurrent symptoms and hospital admissions, hence should be performed whenever technically feasible.

Cited By: 4

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Original Article 2019-04-30

Histopathological examination following side-by-side placement of metal stents for malignant hilar biliary obstruction

Hiroshi Nakagawara , Kenji Yamao, Takuji Gotoda, Daiichiro Kikuta, Akinori Takei, Kunio Iwatsuka, Toshimi Takahashi, Masahiro Ogawa, Akihiro Henmi, Makio Kobayashi, Mitsuhiko Moriyama

https://doi.org/10.18528/ijgii180045

Abstract : Background Endoscopic-guided placement of metal stents for unresectable malignant hilar biliary obstruction (UMHBO) is performed using partial stent-in-stent or side-by-side (SBS) techniques. The latter involves placing sequential stents within the bile duct. Excessive dilation of the bile duct during stent placement can have serious effects on the surrounding organs. Methods This study details seven cases of SBS placement of 8.0 mm metal stents for UMHBO. Histopathological examinations were performed to identify the effects on the bile duct and surrounding tissues. Results The mean post-placement diameter of the bile ducts was 13.86 mm, and no compression necrosis or thrombi were observed in surrounding tissues. Cholangitis occurred in five cases, and death occurred as a result of cholecystitis in one case. Conclusion The use of 8.0-mm stents for SBS is unlikely to have major negative effects on peribiliary tissues and blood vessels. However, post-placement cholecystitis can result in increased mortality; thus, gallbladder drainage should be considered.

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Original Article 2019-04-30

Conversion of percutaneous cholecystostomy to transmural endoscopic ultrasound-guided gallbladder drainage in malignant biliary obstruction

Motoyasu Kan, Yusuke Hashimoto , Taro Shibuki, Gen Kimura, Kumiko Umemoto, Kazuo Watanabe, Mitsuhito Sasaki, Hideaki Takahashi, Hiroshi Imaoka, Izumi Ohno, Shuichi Mitsunaga, Masafumi Ikeda

https://doi.org/10.18528/ijgii180040

Abstract : Background In patients with distal malignant biliary obstruction, it is a challenge to manage acute cholecystitis secondary to cystic duct obstruction associated with tumor progression or stent compression. Percutaneous transhepatic gallbladder drainage (PTGBD) has been used as the treatment option of choice, because of its ease of performance and safety, but because of the use of an external drainage tube, some patients experience a decreased quality of life. We report the technical success and clinical success of conversion from PTGBD to endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) for the treatment of acute cholecystitis in patients with unresectable malignant biliary obstruction. Methods We included the patients with cholecystitis secondary to unresectable malignant biliary obstruction who underwent conversion from PTGBD to EUS-GBD in the study. After PTGBD for the treatment of acute cholecystitis, we performed EUS-GBD and a plastic stent or a self-expandable metal stent (SEMS) was placed for fistulostomy. Results Fourteen patients (median age, 69 years; 9 males and 5 females) underwent conversion to EUS-GBD after clinical improvement of cholecystitis by PTGBD. The technical success rate of the conversion from PTGBD to EUS-GBD was 100% (14/14). EUS-GBD was performed in a median of 9.5 days (range, 3–51 days) after PTGBD procedure, using mainly a plastic stent (13 patients) and a covered SEMS in one patient. The early (within 24 hours) adverse events rate was 14.3% (2/14), and the late (after 24 hours) adverse events rate was 7.1% (1/14). The rate of recurrence of cholecystitis was 28.6% (4/14). These patients underwent endoscopic re-intervention and there were no cases of further recurrence of cholecystitis. Conclusion Conversion of PTGBD to EUS-GBD demonstrated a feasible and safe technique for acute cholecystitis in non-surgical candidates with malignant biliary obstruction.

Cited By: 0

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Original Article 2019-04-30

Efficacy and clinical outcomes of angiography and transcatheter arterial embolization for gastrointestinal bleeding in Crohn’s disease

Minjae Kim, Ji Hoon Shin , Pyeong Hwa Kim, Gi-Young Ko, Hyun-Ki Yoon, Heung-Kyu Ko

https://doi.org/10.18528/ijgii170025

Abstract : Background To retrospectively investigate the use of angiography as a diagnostic tool and evaluate technical and clinical efficacy of transcatheter arterial embolization (TAE) in Crohn’s disease-related gastrointestinal (GI) bleeding. Methods Institutional Review Board approval with waiver of patients’ informed consent requirement was obtained. There were 39 angiographies performed in 24 patients (male:female = 18:6, median age = 25 years) presenting with Crohn’s disease-related GI bleeding between 2001 and 2014. The technical and clinical success rate of TAE as well as procedure-related complications and 2-year mortality rate were evaluated. Clinical factors such as vital signs and laboratory findings as well as other modalities of investigations were analyzed. Results Among 39 angiographies, 25.6% of angiographies were performed as the initial choice of investigation and angiography was performed after endoscopy failed to identify a bleeding site in 33.3%. There were negative angiographic findings in 66.7% (26/39). TAE (n = 13) demonstrated 100% technical success rate and 69.2% (9/13) clinical success rate with one case of ischemic complication and one case of mortality due to combined pneumonia. Ileal branches were the most frequent site of embolization and the combination of gelatin sponge slurry and microcoil was most commonly used. Conclusion Angiography and TAE may be the initial or follow-up management option in patients with Crohn’s disease presenting with acute GI bleeding. Although the rate of negative angiographic findings was high (66.7%), TAE showed high technical success rate and acceptable clinical success rate in patients with positive angiographic findings.

Cited By: 1

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Case Report 2019-04-30

Percutaneous retrograde approach and perioral placement of a covered esophageal stent in a patient with a complex esophageal cancer

Jesus Beltran-Perez , Gregory Ramsey, Jorge E. Lopera

https://doi.org/10.18528/ijgii180018

Abstract : This case report shows an effective esophageal stent placement via retrograde (transgastric) approach under fluoroscopic guidance in the interventional radiology suite. This alternative can be evaluated and offered to patients that suffer from a firm esophageal occlusion before a major procedure such as surgery can be considered. Thus, decreasing major surgery complications and improving the quality of life.

Cited By: 0

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Complication Forum 2019-04-30

Severe necrotizing pancreatitis after endoscopic papillectomy in a patient with ampullary adenoma

Dong Kee Jang, Jeong Yeon Moon, Sang Hyub Lee , Jun Kyu Lee

https://doi.org/10.18528/ijgii190003

Abstract : Summary of Event A 38-year-old man diagnosed with ampullary adenoma was referred for further treatment, and initially treated with the endoscopic papillectomy without complications. Recurred lesions were found during follow-up and second procedure was planned. However, severe necrotizing pancreatitis with small bowel ileus occurred following the second endoscopic papillectomy for the recurred lesion. He had to undergo bypass surgery (gastrojejunostomy) for persistent small bowel ileus, and repetitive percutaneous radiologic interventions for necrotic fluid collections in the abdominal cavity during a 6-month period of hospitalization. Teaching Point During endoscopic papillectomy for ampullary adenoma, every effort to prevent pancreatitis including the decision of appropriate resection extent, prophylactic pancreatic duct stenting, and rectal indomethacin should be made. If severe necrotizing pancreatitis with small bowel ileus occurs, and oral feeding is difficult, early bypass surgery should be considered. In addition, removal of necrotic material in the abdominal cavity requires continuous collaboration among endoscopists, intervention radiologists, and surgeons.

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