1
|
Riaz A, Trivedi P, Aadam AA, Katariya N, Matsuoka L, Malik A, Gunn AJ, Vezeridis A, Sarwar A, Schlachter T, Harmath C, Srinivasa R, Abi-Jaoudeh N, Singh H. Research Priorities in Percutaneous Image and Endoscopy Guided Interventions for Biliary and Gallbladder Diseases: Proceedings from the Society of Interventional Radiology Foundation Multidisciplinary Research Consensus Panel. J Vasc Interv Radiol 2022; 33:1247-1257. [PMID: 35809805 DOI: 10.1016/j.jvir.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/09/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022] Open
Abstract
Recent technological advancements including the introduction of disposable endoscopes have enhanced the role of interventional radiology (IR) in the management of biliary/gallbladder diseases. There are unanswered questions in this growing field. The Society of Interventional Radiology Foundation convened a virtual Research Consensus Panel consisting of a multidisciplinary group of experts, to develop a prioritized research agenda regarding percutaneous image and endoscopy guided procedures for biliary and gallbladder diseases. The panelists discussed current data, opportunities for IR and future efforts to maximize IR's ability and scope. A recurring theme throughout the discussions was to find ways to reduce the total duration of percutaneous drains and to improve the patients' quality of life. Following the presentations and discussions, research priorities were ranked based on their clinical relevance and impact. The research ideas ranked top three were as follows: 1- Percutaneous multimodality management of benign anastomotic biliary strictures (Laser vs endobiliary ablation vs cholangioplasty vs drain upsize protocol alone); 2- Ablation of intraductal cholangiocarcinoma with and without stenting; and 3- Cholecystoscopy/choledochoscopy and lithotripsy in non-surgical patients with calculous cholecystitis. Collaborative retrospective and prospective research studies are essential to answer these questions and to improve the management protocols for patients with biliary/gallbladder diseases.
Collapse
Affiliation(s)
- Ahsun Riaz
- Vascular and Interventional Radiology, Northwestern University, Chicago, IL.
| | - Premal Trivedi
- Vascular and Interventional Radiology, University of Colorado, Aurora, CO
| | | | - Nitin Katariya
- Transplant and Hepatobiliary Surgery, Mayo Clinic, Phoenix, AZ
| | - Lea Matsuoka
- Transplant Surgery, Vanderbilt University, Nashville, TN
| | - Asad Malik
- Vascular and Interventional Radiology, Northwestern University, Chicago, IL
| | - Andrew J Gunn
- Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Ammar Sarwar
- Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Todd Schlachter
- Vascular and Interventional Radiology, Yale University, New Haven, CT
| | - Carla Harmath
- Diagnostic Radiology, University of Chicago, Chicago, IL
| | - Ravi Srinivasa
- Vascular and Interventional Radiology, University College Los Angeles, Los Angeles, CA
| | - Nadine Abi-Jaoudeh
- Vascular and Interventional Radiology, University College Irvine, Irvine, CA
| | - Harjit Singh
- Vascular and Interventional Radiology, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
2
|
Cholecystostomy as an Exclusive Access to Remove Cystic, Common Hepatic, and Common Bile Duct Stones. AJR Am J Roentgenol 2020; 215:1252-1256. [PMID: 32901566 DOI: 10.2214/ajr.19.22469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE. The purpose of this article was to evaluate the feasibility and efficacy of percutaneous fluoroscopic-guided stone retrieval from the cystic duct and antegrade common bile duct (CBD) stone advancement into the duodenum exclusively through a cholecystostomy tube. MATERIALS AND METHODS. Twenty-one patients with acute cholecystitis and choledocholithiasis or an impacted cystic duct stone who underwent percutaneous cholecystostomy tube placement were retrospectively enrolled in this study. The patients had a contra-indication for cholecystectomy (17 patients because of comorbidities and one who declined surgery) or had failed endoscopic retrograde stone removal attempts (three patients). RESULTS. The 21 patients underwent subsequent percutaneous CBD (17 patients) and cystic duct (nine patients) stone removal on follow-up sessions through the percutaneous cholecystostomy track using moderate sedation. A total of 32 stone removal procedures were performed. Seventeen patients underwent balloon dilatation sphincterotomy, after which the CBD stones were pushed forward into the duodenum using a compliant balloon. Seven patients also had stone removal from the cystic duct by a stone retrieval basket. The primary technical success rate for removal of all CBD and cystic duct stones was 76%. The secondary technical success rate was 100%. The clinical success rate was 74%. All patients tolerated the procedures well without major complication. The clinical follow-up interval ranged from 2 to 2310 days (median, 30 days), with no incidence of postprocedural complications. CONCLUSION. Percutaneous transcholecystic common bile and cystic duct stone removal through an existing cholecystostomy access is a safe and effective procedure that is well tolerated.
Collapse
|
3
|
Herr A, Collins D, White M, Mandato K, Keating L, Stark C, Lee H, Siskin G. Percutaneous Biliary Endoscopy for Stones. Tech Vasc Interv Radiol 2019; 22:127-134. [DOI: 10.1053/j.tvir.2019.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
4
|
Srinivasa RN, Chick JFB. Endoscopy for the Interventional Radiologist: An Introduction. Tech Vasc Interv Radiol 2019; 22:117-118. [PMID: 31623749 DOI: 10.1053/j.tvir.2019.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Ravi N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, UCLA Medical Center, Los Angeles, CA.
| | - Jeffrey Forris Beecham Chick
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195.
| |
Collapse
|
5
|
Bundy JJ, Weadock WJ, Chick JFB, Srinivasa RN, Patel N, Johnson E, Khayat M, Jeffers B, Gemmete JJ, Srinivasa RN. Three-Dimensional Printing Facilitates Creation of a Biliary Endoscopy Phantom for Interventional Radiology-Operated Endoscopy Training. Curr Probl Diagn Radiol 2018; 48:456-461. [PMID: 30477812 DOI: 10.1067/j.cpradiol.2018.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/09/2018] [Accepted: 08/16/2018] [Indexed: 01/21/2023]
Abstract
PURPOSE To create a three-dimensional endoscopic model of the biliary tract from magnetic-resonance cholangiopancreatography imaging and to evaluate its effectiveness as a tool for training in endoscopic biliary interventions. MATERIALS AND METHODS A magnetic-resonance cholangiopancreatography study was performed on a patient with biliary obstruction secondary to a distal bile duct cholangiocarcinoma. Using Vitrea, a three-dimensional volume-rendered image was created, and exported as a standard tessellated language file. The standard tessellated language model was then edited with MeshMixer. Three cylindrical entry ports were created. The ports were aligned and overlapped with the dominant ducts in three separate areas of the model and fused to the model. A 0.2 cm shell was created around the model and the model was hollowed. The ends of the ports were cut off, allowing access to the hollowed-out model. The model was printed at 125% scale to allow easy access with a 9.5-French (≤3.23 mm) endoscope. The model was printed using a Stratasys Dimension Elite Plus printer. After printing, the model was post-processed to remove support materials. A 10-question survey was administered to all trainees before and after use of the printed phantom to practice endoscopy skills. RESULTS 11 trainees participated in the three-dimensional endoscopy simulation with most of the trainees (73%) having no prior formal endoscopy training. Using a 10-point Likert scale, the mean comfort-level of the trainees to use endoscopy alone for cholecystostomy, percutaneous biliary drainage, percutaneous nephrostomy, and percutaneous gastrostomy increased by 38.9%, 32.8%, 32.8%, and 34.3%, respectively, following the training experience. CONCLUSION The use of a three-dimensionally printed endoscopic model as a simulation tool has the potential to improve trainee comfort using endoscopy during interventional radiology procedures.
Collapse
Affiliation(s)
- Jacob J Bundy
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI
| | - William J Weadock
- Department of Radiology, Division of Abdominal Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI
| | | | - Rajiv N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI
| | - Nishant Patel
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI
| | - Evan Johnson
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI
| | - Mamdouh Khayat
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI
| | - Brian Jeffers
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI
| | - Joseph J Gemmete
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI
| | - Ravi N Srinivasa
- Department of Interventional Radiology, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095.
| |
Collapse
|
6
|
Percutaneous transgastric interventional radiology-operated duodenoscopy for the identification of duodenal perforation and Graham patch dehiscence. Radiol Case Rep 2017; 12:790-793. [PMID: 29484072 PMCID: PMC5823391 DOI: 10.1016/j.radcr.2017.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/09/2017] [Accepted: 09/11/2017] [Indexed: 12/26/2022] Open
Abstract
Patients with a Roux-en-Y gastric bypass may be challenging diagnostic and therapeutic dilemmas for gastroenterologists and endoscopists due to anatomic considerations. Pancreaticobiliary limb pathology is particularly difficult to diagnose from standard endoscopic approaches as it often requires double balloon enteroscopy. Percutaneous access and gastrostomy placement into the gastric remnant, however, is a commonly performed procedure by interventional radiology. This report describes the identification of duodenal perforation and Graham patch dehiscence in the pancreaticobiliary limb of a patient with a prior Roux-en-Y gastric bypass who had failed traditional endoscopic measures, using transgastric remnant interventional duodenoscopy and confirmed with methylene blue injection into a periduodenal abscess.
Collapse
|
7
|
Chathadi KV, Chen YK. New kid on the block: development of a partially disposable system for cholangioscopy. Gastrointest Endosc Clin N Am 2009; 19:545-55. [PMID: 19917460 DOI: 10.1016/j.giec.2009.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The SpyGlass Direct Visualization System is a significant step forward in bringing optical visualization to the pancreatobiliary system by providing dedicated irrigation and therapeutic channels and 4-way steerability. Peroral cholangioscopy using the SpyGlass System may be safely performed by a single operator and provides reliable access to target sites for visual inspection and stone therapy using electrohydraulic lithotripsy or holmium laser lithotripsy. In addition, the SpyBite Biopsy Forceps has been shown to obtain adequate histologic tissue specimens reliably.
Collapse
Affiliation(s)
- Krishnavel V Chathadi
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado Denver, MS 735, 1653 Aurora Court, Room AIP 2.031, Aurora, CO 80045, USA
| | | |
Collapse
|
8
|
Yoon KH, Ha HK, Kim CG, Roh BS, Yun KJ, Chae KM, Lim JH, Auh YH. Malignant papillary neoplasms of the intrahepatic bile ducts: CT and histopathologic features. AJR Am J Roentgenol 2000; 175:1135-9. [PMID: 11000178 DOI: 10.2214/ajr.175.4.1751135] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. We describe the CT and pathologic features of malignant papillary neoplasms of the intrahepatic bile ducts in 15 patients. CONCLUSION. CT is a useful technique for revealing intraductal lesions, although the findings are nonspecific and variable. When intraductal masses or nodules are seen with localized dilatation of the intrahepatic bile ducts on CT scans, malignant papillary neoplasms of the intrahepatic bile ducts should be included in the differential diagnosis.
Collapse
Affiliation(s)
- K H Yoon
- Department of Radiology, Wonkwang University School of Medicine, 344-2 Singyong-dong, Iksan, Chunbuk 570-180, Korea
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Neri E, Boraschi P, Braccini G, Caramella D, Perri G, Bartolozzi C. MR virtual endoscopy of the pancreaticobiliary tract. Magn Reson Imaging 1999; 17:59-67. [PMID: 9888399 DOI: 10.1016/s0730-725x(98)00127-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the feasibility of surface-rendered magnetic resonance virtual endoscopy (MRVE) of magnetic resonance cholangiopancreatography (MRCP) data sets. We retrospectively reviewed MR cholangiopancreatography data sets of 120 patients with biliary stone (n=40), inflammatory ampullary stenosis (n=12), pancreatic tumor (n=8), cholangiocarcinoma (n=7), stenosis of surgical bilio-enteric anastomosis (n=4), extrinsic localized common bile duct stenosis (n=2), ampullary carcinoma (n=2), pancreatic duct stone (n=1), tumor of the gallbladder (n=1), and normal pancreaticobiliary tree (n=43). MRVE views were generated with Navigator software. Segmentation of the acquired data sets was performed with a thresholding technique. Navigation sequences were simulated through the entire biliary tract. MRVE was obtained in 27 (63%) of the 43 normal patients. Endoscopic views were generated in all 77 patients with partial or complete obstruction of the pancreaticobiliary tree. Among these, three groups of patterns were identified: 36 (47%) endoluminal masses (polyp-like masses), 17 (22%) luminal stenoses, 24 (31%) luminal occlusion. In 29 cases, hole artifacts through the internal wall were observed and interpreted as mistakes of segmentation. MRVE proved to show the internal anatomy of the biliary tract and endoluminal changes due to pathological condition. Further investigations are needed to test the usefulness and the potentialities of this technique.
Collapse
Affiliation(s)
- E Neri
- Diagnostic and Interventional Radiology, University of Pisa, Italy.
| | | | | | | | | | | |
Collapse
|
10
|
Hausegger KA, Mischinger HJ, Karaic R, Klein GE, Kugler C, Kern R, Uggowitzer M, Szolar D. Percutaneous cholangioscopy in obstructed biliary metal stents. Cardiovasc Intervent Radiol 1997; 20:191-6. [PMID: 9134842 DOI: 10.1007/s002709900135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To reevaluate the reasons for the occlusion of self-expanding biliary metal stents, on the basis of cholangioscopic findings. METHODS Percutaneous transhepatic cholangioscopy (PTCS) was performed in 15 patients with obstructed biliary Wallstents. The reason for stent insertion was a malignant obstruction in 14 patients; 1 had a benign biliary stricture. Conventional noncovered stents had been inserted in 12 patients; in 3 cases a polyurethanecovered prototype Wallstent had been used. Stent occlusions occurred after 1-55 months. PTCS was performed with a 2.3-mm endoscope through an 11 Fr sheath. Biopsies were taken via the working channel of the endoscope. RESULTS In all patients with noncovered stents the inner surface of the stent was highly irregular with seaweed-like protrusions (biopsy-proven granulation tissue). Stent incorporation varied from absent (n = 1) to subtotal (n = 8), but was always incomplete, no matter how long the stent had been in place. Tumor ingrowth was histologically proven in 2 patients. One patient had a large occluding concrement at the proximal end of the stent. In patients with covered stents, the inner surface appeared more regular; however, viable granulation tissue was found inside two stents and tumor ingrowth in one of them. CONCLUSION PTCS showed that incorporation of the stent is virtually always incomplete. The factors contributing most to stent occlusion are the buildup of granulation tissue, bile sludge, and tumor overgrowth. Stone formation and tumor ingrowth can also be important, although less common causes of occlusion. A polyurethane stent covering could not prevent tumor ingrowth in one patient and the buildup of viable granulation tissue inside the stent in two further patients; mean stent patency in the three patients with such a stent was 3 months.
Collapse
Affiliation(s)
- K A Hausegger
- Department of Radiology, Karl-Franzens Universität Graz, Austria
| | | | | | | | | | | | | | | |
Collapse
|