IJGII Inernational Journal of Gastrointestinal Intervention

pISSN 2636-0004 eISSN 2636-0012
ESCI

October 31, 2021Current Issue Vol. 10 No. 4

    October, 2021 | Volume 10, No. 4
  • Greetings 2021-10-31

  • Review Article 2021-10-31

    Recent technical advances in conventional transarterial chemoembolization for hepatocellular carcinoma in Japan

    Hiroki Higashihara *, Yusuke Ono , Kaisyu Tanaka et al.

    Abstract : Conventional transarterial chemoembolization (TACE) using ethiodized oil and gelatin sponge (GS) particles is a standard treatment for unresectable BCLC-B stage hepatocellular carcinoma (HCC). Ethiodized oil can cause temporary embolic micro-interactions in tumor sinuses, portal veins, hepatic venous sinuses, and arteries as a temporary embolic material for the microvasculature. Using GS particles as an added embolic material, strong ischemic effects can be achieved not only in HCC, but also in the surrounding liver parenchyma. In recent years, various technical innovations in TACE using ethiodized oil have been made in Japan to improve the outcomes of TACE, such as a device for emulsifying ethiodized oil and water-soluble anticancer drugs, the use of intraoperative embolization guidance software to plan embolization during TACE, and the introduction of various microcatheters. This report examines some of the technical innovations that have been adopted to improve TACE outcomes.

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  • Review Article 2021-10-31

    The update on transcatheter arterial chemoembolization using drug-eluting beads: Optimization for best response

    Jung Suk Oh and Ho Jong Chun

    Abstract : Transcatheter arterial chemoembolization using drug-eluting beads (DEB-TACE) was developed to overcome the shortcomings of conventional TACE (c-TACE) and was expected the better clinical results. Based on the published studies so far, a clear pharmacokinetic superiority or survival benefit of DEB-TACE over cTACE has not been established yet and clinical effect of DEB-TACE is controversy. However, previous published studies on DEBTACE have limitations in optimizing the DEB-TACE procedure due to the lack of detailed subgroup analysis and not including the clinical data of DEB-TACE using recently and newly developed small DEB particles. Aim of this review article is to systematically analyze the published data, especially subgroup analysis, on the optimization for best response in terms of tumor response and safety profile.

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  • Review Article 2021-10-31

    Superselective transarterial radioembolization for the treatment of hepatocellular carcinoma

    Gyoung Min Kim

    Abstract : Superselective transarterial radioembolization (TARE) refers the delivery of Y90 at the tumor-feeding segmental or subsegmental arteries. The purpose of TARE would be delivering high dose in the tumor while saving as much normal parenchyma as possible. This concept is similar to the radiation segmentectomy. To identify all tumor feeders, thorough angiography and cone-beam computed tomography are essential. Reported target dose of radiation segmentectomy ranges 222.6–521 Gy. After superselective TARE, the treated segments can show persistent enhancement, and then atrophy combined with capsular retraction. Superselective TARE promises favorable outcomes. It’s reported objective response rates range 64%–95% and toxicities are tolerable in most cases. In conclusion, superselective TARE is a very safe modality for the treatment of HCCs with favorable outcome close to the curative-intent treatments in selected patients.

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  • Review Article 2021-10-31

    Recent technical advances in radiofrequency ablations for hepatocellular carcinoma

    Dong Ho Lee

    Abstract : Radiofrequency ablation (RFA) has regarded as a curative treatment method for early stage hepatocellular carcinoma (HCC), providing comparable overall survival to surgical resection. However, lack of ideal guiding modality for RFA procedure and higher rate of local tumor progression (LTP) after treatment than surgical resection have been important limitations. To overcome the current limitations of RFA, the fusion imaging between real-time ultrasound and reference computed tomography/magnetic resonance images has been introduced. The fusion imaging could improve the feasibility of RFA for HCC by helping the accurate identification of target HCC, especially for invisible small HCC. In addition, RFA using multiple electrodes with multi-channel generator and various energy delivery modes could improve the therapeutic efficacy, by creating larger ablation volume than RFA using a single electrode. RFA using multiple electrodes can allow no touch ablation technique, which might have a potential to reduce LTP. In this review, these recently introduced ablation techniques will be discussed with the results of both animal and clinical studies.

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  • Review Article 2021-10-31

    Current role of proton beam therapy in patients with hepatocellular carcinoma

    Gyu Sang Yoo , Jeong Il Yu , and Hee Chul Park

    Abstract : Hepatocellular carcinoma (HCC) is the most common primary liver cancer, the sixth most common cancer, and the fourth leading cause of cancer related deaths worldwide. There are curative local treatment options for HCC, including liver transplantation, surgical resection, and radiofrequency ablation, all of which are applicable for a few patients. For advanced HCC, systemic treatments, such as target agents or immunotherapies, are recommended, however, with unsatisfactory efficacy. Therefore, radiation therapy (RT) has been used as an alternative or combination therapy. With the advances of RT technique in image guidance and accurate beam delivery, its applications have increased for the management of HCC. Proton beam therapy (PBT) is a highly advanced RT technique. Since proton beams have unique physical properties with a finite range in the distal direction, PBT has the potential to escalate the radiation dose without a significant increase in the risk of complications compared with X-ray therapy in the treatment of HCC. Various studies have reported favorable oncological outcomes and toxicity risks of PBT for HCC patients. In this review, we discuss the physical and biological properties, technical issues, current clinical data, and future perspectives on PBT for the treatment of HCC patients.

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  • Review Article 2021-10-31

    Current role of systemic therapy in transarterial chemotherapy refractory hepatocellular carcinoma patients

    Hansung Kang and Hye Won Lee

    Abstract : Transarterial chemotherapy (TACE) is the standard treatment for patients with intermediate-stage hepatocellular carcinoma (HCC), defined as large, unresectable, or multinodular HCC in patients with good functional performance. The definition of TACE refractoriness is not well established. Generally, TACE refractoriness is defined as an insufficient response after two or more consecutive TACE. An increase in the number of liver lesions, continuously elevated tumor markers, vascular invasion, and extrahepatic spread also suggest TACE refractoriness. Timely switching to systemic therapy for TACE refractoriness should be considered to improve the outcome. Although data are sparse, the combination of anti-angiogenic and immune checkpoint inhibitor therapies shows promise for TACE-refractory patients. In this article, we review the role of systemic therapy in TACE refractory patients with HCC.

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  • Case Report 2021-10-31

    Stent occlusion in endoscopic ultrasound-guided gallbladder drainage from bleeding mitigated by double pigtail plastic stent deployment within lumen apposing metal stent

    Murali Dharan

    Abstract : Double pigtail plastic stents (DPTPS) are routinely placed with the lumen apposing metal stent (LAMS) during endoscopic ultrasound-guided gall bladder drainage. Several reasons are postulated for this practice. This case report highlights a previously unreported benefit from use of DPTPS within LAMS.

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  • Case Report 2021-10-31

    A rare but lethal complication: Post-endoscopic retrograde cholangiopancreatography cerebral arterial gas embolism

    Hin San Chow , Clarence Mak , Wai Yin Chu et al.

    Abstract : Iatrogenic air embolism is a rare and potentially fatal complication of gastrointestinal endoscopy. We present a 66-year-old male patient who developed cerebral arterial gas embolism shortly after therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for acute biliary pancreatitis, which is the first case reported in Hong Kong according to latest literature search. Some risk factors of iatrogenic air embolism in this patient include cholangitis with intraductal stones, sphincterotomy and bleeding at papillotomy site which required haemostasis with balloon tamponade. Early diagnosis and timely treatment with hyperbaric oxygen therapy resulted in full neurological recovery of our patient.

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  • Case Report 2021-10-31

    Concomitant endoscopic biliary, duodenal and colonic stent placement for advanced carcinoma of gall bladder

    Sridhar Sundaram , Sidharth Harindranath , Praveen Kumar Rao et al.

    Abstract : Combined biliary and duodenal stent placement has been reported previously in multiple series. Rarely, colonic obstruction may present simultaneously with duodenal and biliary obstruction in advanced pancreaticobiliary cancers. Biliary, duodenal and colonic obstruction managed simultaneously using endoscopic modalities have been reported in only one case report previously. Here we report outcomes of a case of carcinoma of the gall bladder with biliary, gastric outlet and colonic obstruction managed by endoscopic placement of biliary, gastroduodenal and colonic self-expanding metal stents.

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pISSN 2636-0004 eISSN 2636-0012