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Kohli DR, Smith C, Chaudhry O, Desai M, DePaolis D, Sharma P. Direct Percutaneous Endoscopic Gastrostomy Versus Radiological Gastrostomy in Patients Unable to Undergo Transoral Endoscopic Pull Gastrostomy. Dig Dis Sci 2023; 68:852-859. [PMID: 35708794 DOI: 10.1007/s10620-022-07569-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/17/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS A subset of patients needing long-term enteral access are unable to undergo a conventional transoral "pull" percutaneous endoscopic gastrostomy (PEG). We assessed the safety and efficacy of an introducer-style endoscopic direct PEG (DPEG) and an interventional radiologist guided gastrostomy (IRG) among patients unable to undergo a pull PEG. METHODS In this single center, non-randomized, pilot study, patients unable to undergo a transoral Pull PEG were prospectively recruited for a DPEG during the index endoscopy. IRG procedures performed at our center served as the comparison group. The primary outcome was technical success and secondary outcomes included 30-day and 90-day all-cause mortality, procedure duration, dosage of medications, adverse events, and 30-day all-cause hospitalization. The Charlson comorbidity index was used to compare comorbidities. RESULTS A total of 47 patients (68.3 ± 7.13 years) underwent DPEG and 45 patients (68.6 ± 8.23 years) underwent IRG. The respective Charlson comorbidity scores were 6.37 ± 2 and 6.16 ± 1.72 (P = 0.59). Malignancies of the upper aerodigestive tract were the most common indications for DPEG and IRG (42 vs. 37; P = 0.38). The outcomes for DPEG and IRG were as follows: technical success: 96 vs. 98%; P = 1; 30-day all-cause mortality: 0 vs 15%, P < 0.01; 90-day all-cause mortality: 0 vs. 31%, P < 0.001; 30-day hospitalization: 19 vs. 38%; P = 0.06; procedure duration: 23.8 ± 1.39 vs. 29.5 ± 2.03 min, P = 0.02; midazolam dose: 4.5 ± 1.6 vs. 1.23 ± 0.6 mg; P < 0.001, and opiate dose: 105.6 ± 38.2 vs. 70.7 ± 34.5 µg, P < 0.001, respectively. Perforation of the colon during IRG was the sole serious adverse event. CONCLUSION DPEG is a safe and effective alternative to IRG in patients unable to undergo a conventional transoral pull PEG and may be considered as a primary modality for enteral support. CLINICALTRIALS gov Identifier: NCT04151030.
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Affiliation(s)
- Divyanshoo R Kohli
- Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, 4801 E Linwood Blvd, Kansas City, MO, 64128, USA.
- Pancreas and Liver Clinic, Providence Sacred Heart Medical Center, Spokane, WA, USA.
| | - Craig Smith
- Division of Interventional Radiology, Kansas City VA Medical Center, Kansas City, MO, USA
| | - Omer Chaudhry
- Division of Interventional Radiology, Kansas City VA Medical Center, Kansas City, MO, USA
| | - Madhav Desai
- Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, 4801 E Linwood Blvd, Kansas City, MO, 64128, USA
| | - Dion DePaolis
- Division of Interventional Radiology, Kansas City VA Medical Center, Kansas City, MO, USA
| | - Prateek Sharma
- Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, 4801 E Linwood Blvd, Kansas City, MO, 64128, USA
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Khayat A, Khayat M, Cline M, Riaz A. Percutaneous Biliary Endoscopy. Semin Intervent Radiol 2021; 38:340-347. [PMID: 34393344 DOI: 10.1055/s-0041-1731372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Biliary endoscopy is underutilized by interventional radiologists and has the potential to become an effective adjunctive tool to help both diagnose and treat a variety of biliary pathology. This is particularly true in cases where endoscopic retrograde cholangiopancreatography fails or is not feasible due to surgically altered anatomy. Both preoperative clinical and technical procedural factors must be taken into consideration prior to intervention. In this article, clinical evaluation, perioperative management, and procedural techniques for percutaneous biliary endoscopy are reviewed.
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Affiliation(s)
- Adam Khayat
- NYU Long Island School of Medicine, Mineola, New York
| | - Mamdouh Khayat
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael Cline
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ahsun Riaz
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
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Marmo R, Soncini M, Marmo C, Borbjerg Laursen S, Gralnek IM, Stanley AJ. Medical care setting is associated with survival in acute upper gastro-intestinal bleeding: A cohort study. Dig Liver Dis 2020; 52:561-565. [PMID: 32111388 DOI: 10.1016/j.dld.2020.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are limited data on the effect of the medical care setting on survival in patients admitted with acute upper gastrointestinal bleeding. AIMS To identify the organisational and care setting which provides the optimal survival in patients with acute upper gastrointestinal bleeding. METHODS A retrospective observational study of administrative data from a cohort of patients admitted to a Regional or Local hospital, and cared for in a gastroenterology or general ward. PRIMARY OUTCOME 30 day survival for non-variceal bleeding and 42 day survival for variceal bleeding. RESULTS Out of 3368 patients, the source of bleeding was non-variceal in 2980 (88.5%). Survival, adjusted for clinical and organisational factors, was higher in patients admitted to a gastroenterology ward vs other wards (OR = 2.02 p < 0.0006). Management in a gastroenterology ward in a Regional hospital provided a higher survival rate (95.6% ± 0.08) vs a non-gastroenterology ward in a Local hospital (92.9% ± 0.05 p < 0.01) or a non-gastroenterology ward in a Regional hospital (89.5% ± 0.01 p < 0.0001). Survival (94.0% ± 1.6) in a Local hospital with a gastroenterology ward was significantly higher than in a Regional hospital without (89.5% ± 1.1) p < 0.01. CONCLUSION Survival was optimal for patients treated in a gastroenterology ward independently of Regional or Local hospital setting.
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Affiliation(s)
- Riccardo Marmo
- Gastroenterology Unit, L. Curto Hospital, Polla, SA, Italy.
| | - Marco Soncini
- Digestive Physiopathology Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | | | - Stig Borbjerg Laursen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ian Mark Gralnek
- Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel; Rappaport Family Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Adrian J Stanley
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
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Park M, Kim JW, Shin JH. Endovascular hemostasis for endoscopic procedure-related gastrointestinal bleeding. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2019. [DOI: 10.18528/ijgii190009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Minho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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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.
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Patel N, Chick JFB, Gemmete J, Pampati R, Johnson E, Srinivasa R. Interventional radiology-operated endoscopy using the LithoVue disposable endoscope: Approach, technical success, clinical outcomes, and complications. Indian J Radiol Imaging 2018; 28:350-353. [PMID: 30319214 PMCID: PMC6176675 DOI: 10.4103/ijri.ijri_82_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: To report the approach, technical success, clinical outcomes, and complications of interventional radiology-operated endoscopy using the LithoVue disposable endoscope. Materials and Methods: 12 patients, 6 (50%) males and 6 (50%) females, underwent interventional radiology-operated endoscopy using the LithoVue disposable endoscope between April 2016 and August 2017. Presenting complaint, reason for endoscopic evaluation, technical success, clinical success, procedure time, fluoroscopy time, hospital length of stay, and complications were recorded. Results: Interventional radiology-operated endoscopy using the LithoVue disposable endoscope was used in 8 (67%) biliary, 2 (16.5%) urologic, and 2 (16.5%) gastrointestinal procedures. Five (42%) patients required endoscopy to locate an ostium that could not be cannulated under fluoroscopy. Five (42%) patients had a biliary-enteric anastomosis with postoperative anatomy of the bowel which precluded endoscopic retrograde cholangiopancreatography and underwent endoscopy for removal of calculi. One (8%) patient underwent treatment of a stricture and one (8%) underwent biopsy. Technical success was 92% (11/12). Clinical success was 83% (10/12). Two complications, a perinephric hematoma and sepsis, occurred. Conclusion: Disposable endoscopes, including the LithoVue, may be used in a variety of procedures to improve patient care and limit fluoroscopy.
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Affiliation(s)
- Nishant Patel
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Jeffrey Forris Beecham Chick
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Joseph Gemmete
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Rudra Pampati
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Evan Johnson
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Ravi Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
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Storace M, Martin JG, Shah J, Bercu Z. CTA As an Adjuvant Tool for Acute Intra-abdominal or Gastrointestinal Bleeding. Tech Vasc Interv Radiol 2017; 20:248-257. [DOI: 10.1053/j.tvir.2017.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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