[Percutaneous abdominopelvic interventional procedures using real-time CT fluoroscopy guidance at 21 mAs: an analysis of 99 consecutive cases]

Evaluation of the clinical benefit of an electromagnetic navigation system for CT-guided interventional radiology procedures in the thoraco-abdominal region compared with conventional CT guidance (CTNAV II): study protocol for a randomised controlled trial

BACKGROUND

Interventional radiology includes a range of minimally invasive image-guided diagnostic and therapeutic procedures that have become routine clinical practice. Each procedure involves a percutaneous needle insertion, often guided using computed tomography (CT) because of its availability and usability. However, procedures remain complicated, in particular when an obstacle must be avoided, meaning that an oblique trajectory is required. Navigation systems track the operator's instruments, meaning the position and progression of the instruments are visualised in real time on the patient's images. A novel electromagnetic navigation system for CT-guided interventional procedures (IMACTIS-CT®) has been developed, and a previous clinical trial demonstrated improved needle placement accuracy in navigation-assisted procedures. In the present trial, we are evaluating the clinical benefit of the navigation system during the needle insertion step of CT-guided procedures in the thoraco-abdominal region.

METHODS/DESIGN

This study is designed as an open, multicentre, prospective, randomised, controlled interventional clinical trial and is structured as a standard two-arm, parallel-design, individually randomised trial. A maximum of 500 patients will be enrolled. In the experimental arm (navigation system), the procedures are carried out using navigation assistance, and in the active comparator arm (CT), the procedures are carried out with conventional CT guidance. The randomisation is stratified by centre and by the expected difficulty of the procedure. The primary outcome of the trial is a combined criterion to assess the safety (number of serious adverse events), efficacy (number of targets reached) and performance (number of control scans acquired) of navigation-assisted, CT-guided procedures as evaluated by a blinded radiologist and confirmed by an expert committee in case of discordance. The secondary outcomes are (1) the duration of the procedure, (2) the satisfaction of the operator and (3) the irradiation dose delivered, with (4) subgroup analysis according to the expected difficulty of the procedure, as well as an evaluation of (5) the usability of the device.

DISCUSSION

This trial addresses the lack of published high-level evidence studies in which navigation-assisted CT-guided interventional procedures are evaluated. This trial is important because it addresses the problems associated with conventional CT guidance and is particularly relevant because the number of interventional radiology procedures carried out in routine clinical practice is increasing.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01896219 . Registered on 5 July 2013.

Endoscopic ultrasound-guided pelvic and prostatic abscess drainage: experience in 30 patients

BACKGROUND

Endoscopic ultrasound (EUS)-guided drainage is an effective treatment for many abscesses in the abdomen. We review our experience with EUS-guided drainage of pelvic abscesses.

METHODS

Thirty consecutive patients who underwent EUS-guided pelvic abscess drainage were evaluated after excluding three patients with distance to transducer >2 cm or organized abscess.

RESULTS

Thirty patients (25 male) aged 60 ± 4.5 years (mean ± SD) had 4 prostatic abscesses, 7 perisigmoid abscesses, and 19 perirectal abscesses with mean ± SD sizes of 2.5 ± 0.3, 4.7 ± 0.6, and 5.4 ± 0.4 cm, respectively. Surgery was the most common predisposing factor (n = 14, 46.6 %) followed by diverticulitis (n = 5, 16.6 %). Interventions included aspiration only (2 prostatic and 3 perisigmoid), aspiration and dilatation (2 patients in each group), and dilatation and stenting (2 perisigmoid and 17 perirectal). Five (16.6 %) patients needed re-intervention, and two (6.6 %) needed surgery. There were no recurrences. Technical success of EUS-guided pelvic abscess drainage overall was 90.9 % (30/33) and was 93.3 % (27/30) in patients in whom EUS-guided drainage was attempted, with 16.5 % (n = 5) re-intervention rate.

CONCLUSION

EUS-guided drainage has an excellent success rate in drainage of pelvic abscesses.

Endoscopic ultrasound-guided drainage of pelvic collections and abscesses

Pelvic abscesses are usually the end stage in the progression of an infection. They may occur from surgical complications, generalized abdominal infections such as appendicitis or diverticulitis, or from localized infections such as pelvic inflammatory disease or inflammatory bowel disease. Although surgery has been considered as the treatment of choice by some authors, pelvic abscesses can be managed by non-invasive methods such as ultrasound and computed tomography-guided drainage. The development of therapeutic linear echoendoscopes has allowed the endoscopist to perform therapeutic procedures. Recently, endoscopic ultrasonography (EUS)-guided drainage of pelvic collections has been demonstrated to be feasible, efficient and safe. It allows the endoscopist to insert stents and drainage catheters into the abscess cavity which drains through the large bowel. This article reviews technique, current results and future prospects of EUS-guided drainage of pelvic lesions.