Transportal intravariceal sclerotherapy with N-butyl-2-cyanoacrylate for gastric varices

Four patients with gastric varices without catheterizable draining veins through a systemic vein were treated with transportal intravariceal sclerotherapy with n-butyl-2-cyanoacrylate (NBCA). In all patients, the gastric varices were successfully obliterated with 2-5 mL of NBCA-lipiodol mixture injected via a microcatheter introduced into the varices with transhepatic or transileocolic portal venous access. No complications related to the procedure were encountered. Follow-up gastroendoscopy showed disappearance (n = 3) or marked decrease (n = 1) of the varices. Neither recurrent gastric varices nor variceal bleeding were observed during the follow-up period (6-46 months). Transportal intravariceal sclerotherapy is useful for obliteration of gastric varices in selected cases.     

Triaxial system in bronchial arterial embolization for haemoptysis using N-butyl-2-cyanoacrylate

Objective:

The application of bronchial artery embolization (BAE) using N-butyl-2-cyanoacrylate (NBCA) for haemoptysis was recently reported to be useful. A triple co-axial (triaxial) system consisting of a 4-Fr catheter, 2.7-Fr microcatheter and 1.9-Fr no-taper microcatheter has been developed. The aim of the present study was to evaluate the usefulness of the triaxial system in BAE using NBCA.

Methods:

12 patients with haemoptysis, 8 males and 4 females with a median age of 64 years (range, 49–88 years), underwent BAE between August 2012 and October 2014. Medical records and images were reviewed, and the technical success rate, clinical success rate, haemoptysis-free rate and complications were evaluated. Technical success was defined as the complete cessation of the target artery as confirmed by digital subtraction angiography, whereas clinical success was defined as the cessation of haemoptysis within 24 h of BAE. Recurrent haemoptysis was defined as a total of >30 ml of bleeding per day.

Results:

The target artery was embolized successfully in all patients, and the technical success rate was 100% (12/12). The cessation of haemoptysis was achieved in 11 out of 12 patients within 24 h, and thus, the clinical success rate was 92% (11/12). The 6-, 12- and 24-month haemoptysis-free rates were 89%, 89% and 76%, respectively. No patients exhibited any signs of complications such as spinal ischaemia.

Conclusion:

BAE using the triaxial system and NBCA appears to be a useful and safe procedure for haemoptysis.

Advances in knowledge:

The triaxial system contributes to safe and effective BAE using NBCA.     

Efficacy and Safety of Balloon-Occluded Retrograde Transvenous Obliteration with Sodium Tetradecyl Sulfate Liquid Sclerotherapy

Objective

To evaluate the efficacy and safety of balloon-occluded retrograde transvenous obliteration (BRTO) with sodium tetradecyl sulfate (STS) liquid sclerotherapy of gastric varices.

Materials and Methods

Between February 2012 and August 2014, STS liquid sclerotherapy was performed in 17 consecutive patients (male:female = 8:9; mean age 58.6 years, range 44–86 years) with gastric varices. Retrograde venography was performed after occlusion of the gastrorenal shunt using a balloon catheter and embolization of collateral draining veins using coils or gelfoam pledgets, to evaluate the anatomy of the gastric varices. We prepared 2% liquid STS by mixing 3% STS and contrast media in a ratio of 2:1. A 2% STS solution was injected into the gastric varices until minimal filling of the afferent portal vein branch was observed (mean 19.9 mL, range 6–33 mL). Patients were followed up using computed tomography (CT) or endoscopy.

Results

Technical success was achieved in 16 of 17 patients (94.1%). The procedure failed in one patient because the shunt could not be occluded due to the large diameter of gastrorenal shunt. Complete obliteration of gastric varices was observed in 15 of 16 patients (93.8%) with follow-up CT or endoscopy. There was no rebleeding after the procedure. There was no procedure-related mortality.

Conclusion

BRTO using STS liquid can be a safe and useful treatment option in patients with gastric varices.     

Transcatheter Arterial Embolization of Nonvariceal Upper Gastrointestinal Bleeding with N-Butyl Cyanoacrylate

Objective

To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-Butyl Cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal bleeding.

Materials and Methods

Between March 1999 and December 2002, TAE for nonvariceal upper gastrointestinal bleeding was performed in 93 patients. The endoscopic approach had failed or was discarded as an approach for control of bleeding in all study patients. Among the 93 patients NBCA was used as the primary embolic material for TAE in 32 patients (28 men, four women; mean age, 59.1 years). The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery. TAE was performed using 1:1-1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated.

Results

The angiographic and clinical success rates were 100% and 91% (29/32), respectively. There were no serious ischemic complications. Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2). Eighteen patients (56%) had a coagulopathy at the time of TAE and the clinical success rate in this group of patients was 83% (15/18).

Conclusion

TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy.     

Sclerotherapy of Peritoneal Inclusion Cysts: Preliminary Results in Seven Patients

Objective

To evaluate the technical feasibility and the clinical effectiveness of sclerotherapy for the treatment of peritoneal inclusion cysts (PICs).

Materials and Methods

Between June 1996 and February 2001, eight PICs in seven female patients aged 28-43 (mean, 36) years were instilled with sclerosant (povidone-iodine in three, ethanol in three, both povidone-iodine and ethanol in one). All seven patients subsequently experienced less abdominal pain. After drainage via an 8.5-Fr pigtail catheter inserted in the PICs (transabdominally in six cases, transvaginally in one), sclerosant equivalent in volume to about one-third that of drained fluid was introduced daily until the drained volume was less than 5ml. Follow-up by means of clinical procedures and ultrasound was performed every three months, at which time the success rate, possible complications and recurrence were determined.

Results

Sclerotherapy was technically successful in all seven patients, though immediately after the procedure, minor complications were noted in three patients (mild pain in two, mild fever in one). During the follow-up of 4-60 (mean, 24.7) months, sclerotherapy proved successful and without long-term complications in all seven patients: lower abdominal pain disappeared and the diameter of the cysts decreased more than 50%, with complete regression in four cases. During the follow-up period there was no recurrence.

Conclusion

Sclerotherapy following catheter insertion is technically feasible and effective for the treatment of PICs.     

Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Variceal Bleeding: Its Feasibility Compared with Transjugular Intrahepatic Portosystemic Shunt

Objective

To assess the feasibility of balloon-occluded retrograde transvenous obliteration (BRTO) in active gastric variceal bleeding, and to compare the findings with those of transjugular intrahepatic portosystemic shunt (TIPS).

Materials and Methods

Twenty-one patients with active gastric variceal bleeding due to liver cirrhosis were referred for radiological intervention. In 15 patients, contrast-enhanced CT scans demonstrated gastrorenal shunt, and the remaining six (Group 1) underwent TIPS. Seven of the 15 with gastrorenal shunt (Group 2) were also treated with TIPS, and the other eight (Group 3) underwent BRTO. All patients were followed up for 6 to 21 (mean, 14.4) months. For statistical inter-group comparison of immediate hemostasis, rebleeding and encephalopathy, Fisher''s exact test was used. Changes in the Child-Pugh score before and after each procedure in each group were statistically analyzed by means of Wilcoxon''s signed rank test.

Results

One patient in Group 1 died of sepsis, acute respiratory distress syndrome, and persistent bleeding three days after TIPS, while the remaining 20 survived the procedure with immediate hemostasis. Hepatic encephalopathy developed in four patients (one in Group 1, three in Group 2, and none in Group 3); one, in Group 2, died while in an hepatic coma 19 months after TIPS. Rebleeding occurred in one patient, also in Group 2. Except for transient fever in two Group-3 patients, no procedure-related complication occurred. In terms of immediate hemostasis, rebleeding and encephalopathy, there were no statistically significant differences between the groups (p > 0.05). In Group 3, the Child-Pugh score showed a significant decrease after the procedure (p = 0.02).

Conclusion

BRTO can effectively control active gastric variceal bleeding, and because of immediate hemostasis, the absence of rebleeding, and improved liver function, is a good alternative to TIPS in patients in whom such bleeding, accompanied by gastrorenal shunt, occurs.     

Cyst Ablation Using a Mixture of N-Butyl Cyanoacrylate and Iodized Oil in Patients with Autosomal Dominant Polycystic Kidney Disease: the Long-Term Results

Objective

We wanted to assess the long-term results of cyst ablation with using N-butyl cyanoacrylate (NBCA) and iodized oil in patients with autosomal dominant polycystic kidney disease (ADPKD) and symptomatic cysts.

Materials and Methods

Cyst ablation using a mixture of NBCA and iodized oil was performed in 99 cysts from 21 patients who had such symptoms as abdominal distension and pain. The collapse or reaccumulation of the ablated cysts after the procedure was assessed during the follow-up period of 36 to 90 months. The treatment effects, including symptom relief, and the clinical data such as the blood pressure and serum creatinine levels were also assessed, together with the complications.

Results

The procedure was technically successful in all 99 cysts from the 21 patients. Any procedure-related significant complications were not detected. Seventy-seven of 99 cysts (78%) were successfully collapsed on the follow-up CT. Twenty-two cysts showed reaccumulation during long-term follow-up period. The clinical symptoms were relieved in 17 of the 21 patients (76%). Four of 12 patients (33%) with hypertension and two of six patients (33%) with azotemia were improved. End stage renal disease (ESRD) occurred in six of the 21 patients (28%) during the follow-up period. The mean age of ESRD in our patients was 57 years. The mean time interval for the development of ESRD was 19 months.

Conclusion

Ablation using a mixture of NBCA and iodized oil may be an effective, safe method for obtaining symptom relief in patients with ADPKD.     

Use of the triaxial microcatheter method in super-selective transcatheter arterial chemoembolisation for hepatocellular carcinoma

Objectives

Transcatheter arterial chemoembolisation (TACE) has been widely used for inoperable hepatocellular carcinoma (HCC). Super-selective TACE is preferable to non-selective therapy, because it maximises the impact of treatment on the tumour while minimising damage to tumour-free liver parenchyma. It is therefore important to advance the catheter tip as close as possible in the feeding artery. There is now a new microcatheter with a 1.9-Fr tip with no taper, which can be inserted into a 2.7-Fr microcatheter. In this study we describe the new technique of using the two microcatheters called the triaxial microcatheter method.

Methods

We evaluated 30 TACE procedures to investigate whether or not the catheter tip could be advanced closer to HCC with the triaxial microcatheter method than with previous TACE using a conventional microcatheter.

Results

With conventional microcatheters, the level of embolisation was a lobar artery in 4 cases, segmental in 8 cases, subsegmental in 15 cases and sub-subsegmental in only 1 case. TACE could not be performed in two cases. When using the triaxial microcatheter method the level of embolisation was subsegmental in 8 cases, including 2 in which the level was the same as that with a conventional microcatheter, sub-subsegmental in 13 cases and more distal in 7 cases. In the two cases in which TACE could not be performed with the conventional microcatheter, it could be performed sufficiently using the new method. As a whole, in 28 of the 30 procedures (93%) we could successfully advance a catheter tip closer than with the previous TACE.

Conclusion

The triaxial microcatheter method appears to be useful.Hepatocellular carcinoma (HCC) is the most common primary neoplasm of the liver [1]. The incidence of HCC is particularly high in South East Asia and sub-Saharan Africa, but there is a clear rise in the incidence in Western Europe and the United States [2].Transcatheter arterial chemoembolisation (TACE) has been widely used in cases of HCC during the past 15 years. Digital subtraction angiography and advanced catheter technology have enabled super-selective catheterisation of the arterial branches feeding the tumour, particularly microcatheters in which the appearance of the microcatheter has contributed largely to this. Selective TACE is preferable to non-selective therapy because a selective approach maximises the impact of treatment on the tumour while decreasing collateral damage to tumour-free liver parenchyma [3–5]. Therefore, it is necessary to advance the catheter tip to the tumour as close as possible in the feeding artery. However, sometimes this may be difficult owing to vessel tortuosity or shape of the bifurcation and may result in sagging of the microcatheter or distal catheter displacement beyond the desired vessel ostium.There is now a new microcatheter available that has a 1.9-Fr tip with no taper. It can be inserted into a 2.7-Fr microcatheter, which has a large inner diameter and is usually used when a better quality angiogram is desired. We hypothesised that by using a 1.9-Fr no-taper microcatheter and 2.7-Fr microcatheter it should be possible to advance the catheter closer to the HCC. We thought the 2.7-Fr microcatheter would give a more stable position for the advancement of the 1.9-Fr no-taper microcatheter into the feeding artery. In this article we describe this new technique as the triaxial microcatheter method.     

Percutaneous Access via the Recanalized Paraumbilical Vein for Varix Embolization in Seven Patients

Objective

To evaluate the feasibility of percutaneous access via the recanalized paraumbilical vein for varix embolization.

Materials and Methods

Between July 2008 and Jan 2014, percutaneous access via the recanalized paraumbilical vein for varix embolization was attempted in seven patients with variceal bleeding. Paraumbilical vein puncture was performed under ultrasonographic guidance, followed by introduction of a 5-Fr sheath. We retrospectively evaluated the technical feasibility, procedure-related complications, and clinical outcomes of each patient.

Results

Recanalized paraumbilical vein catheterization was performed successfully in all patients. Gastroesophageal varix embolization was performed in six patients, and umbilical varix embolization was performed in one patient. Embolic materials used are N-butyl cyanoacrylate (n = 6) and coil with N-butyl cyanoacrylate (n = 1). There were no procedure-related complications. One patient underwent repeated variceal embolization 6 hours after initial procedure via recanalized paraumbilical vein, due to rebleeding from gastric varix.

Conclusion

Percutaneous access via the paraumbilical vein for varix embolization is a simple alternative in patients with portal hypertension.     

Fluoroscopy-Guided Endovenous Sclerotherapy Using a Microcatheter Prior to Endovenous Laser Ablation: Comparison between Liquid and Foam Sclerotherapy for Varicose Tributaries

Objective

To compare the efficacy and adverse effects of endovenous foam sclerotherapy (EFS) and liquid sclerotherapy (ELS) using a microcatheter for the treatment of varicose tributaries.

Materials and Methods

From December 2007 to January 2009, patients with venous reflux in the saphenous vein were enrolled. The foam or liquid sclerosant was injected through a microcatheter just before endovenous laser ablation (EVLA). Patients were evaluated for the technical success, clinical success, and procedure-related complications during the procedure and follow-up visits.

Results

A total of 94 limbs were included: 48 limbs (great saphenous vein [GSV], 35; small saphenous vein [SSV], 13) were managed using EFS and EVLA (foam group; FG), and 46 limbs (GSV, 37; SSV, 9) were treated by ELS and EVLA (liquid group; LG). Varicose tributaries demonstrated complete sclerosis in 92.7% with FG and in 71.8% with LG (p = 0.014). Bruising (78.7% in FG vs. 73.2% in LG, p > 0.05), pain or tenderness (75.6% in FG vs. 51.2% in LG, p = 0.0237) were noted. Hyperpigmentation (51.2% in FG vs. 46.2% in LG, p > 0.05) was found.

Conclusion

Endovenous foam sclerotherapy using a microcatheter is more effective than ELS for eliminating remnant varicose tributaries prior to EVLA. However, EFS is more commonly associated with local complications such as pain or tenderness than ELS. Furthermore, both techniques seem to prolong the duration of hyperpigmentation along with higher costs.     

Ablation of Symptomatic Cysts Using Absolute Ethanol in 11 Patients with Autosomal-Dominant Polycystic Kidney Disease

Objective

To evaluate the effects of cyst ablation with absolute ethanol in autosomal-dominant polycystic kidney disease (ADPKD) patients with symptomatic cysts.

Materials and Methods

Using absolute ethanol, cyst ablation was performed in 11 patients with documented ADPKD who suffered cyst pain refractory to medical treatment. An ethanol solution was instilled into the largest symptomatic cysts through a catheter. We assessed the therapeutic efficacy of the procedure by tracking subjective pain relief during a 3 to 24-month follow-up period after ablation.

Results

At follow-up, we found that the duration of subjective pain relief was 12 to 24 months in seven patients, 4 to11 months in one, and less than 3 months in three.

Conclusion

Selective ablation of a symptomatic cyst may be a valid option in managing chronic pain caused by one or a few large cysts in ADPKD patients.     

Percutaneous Sclerotherapy of Renal Cysts with a Beta-Emitting Radionuclide, Holmium-166-chitosan Complex

Objective

To evaluate the usefulness of a beta-emitting radionuclide (holmium-166-chitosan complex) as a sclerosing agent for the treatment of renal cysts.

Materials and Methods

Using 10-30 mCi of holmium-166-chitosan complex, 20 renal cysts in 17 patients (14 male and 3 female patients, ranging in age from 47 to 82 years) were treated by percutaneous sclerotherapy under ultrasonographic guidance. The volume of the cysts before and after the sclerotherapy and the percentage change in volume were calculated in order to evaluate the response to therapy, which was classified as either complete regression (invisible), nearly complete regression (< 15 volume% of initial volume), partial regression (15-50 volume%) or no regression (> 50 volume%).

Results

The follow-up period ranged from 6 to 36 months (mean 28 months). Eighteen cysts (90%) regressed completely (n=11, 55%) or near-completely (n=7, 35%). Partial regression was obtained in one patient (5%) and there was no regression in one patient (5%). No significant complications were encountered.

Conclusion

The holmium-166-chitosan complex seems to be useful as a new painless sclerosing agent for the treatment of renal cysts with no significant complications.     

Percutaneous Placement of Self-Expandable Metallic Stents in Patients with Obstructive Jaundice Secondary to Metastatic Gastric Cancer after Gastrectomy

Objective

To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy.

Materials and Methods

Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated.

Results

The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL ± 6.8 before stent insertion, decreased to 4.58 mg/dL ± 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 ± 99 days, and the median patient survival was 179 ± 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009).

Conclusion

Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure.     

Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

Objective

To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis.

Materials and Methods

Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique.

Results

Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days).

Conclusion

Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis.     

Transcatheter Arterial Embolization of Arterial Esophageal Bleeding with the Use of N-Butyl Cyanoacrylate

Objective

To evaluate the clinical efficacy and safety of a transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) for the treatment of arterial esophageal bleeding.

Materials and Methods

Between August 2000 and April 2008, five patients diagnosed with arterial esophageal bleeding by conventional angiography, CT-angiography or endoscopy, underwent a TAE with NBCA. We mixed NBCA with iodized oil at ratios of 1:1 to 1:4 to supply radiopacity and achieve a proper polymerization time. After embolization, we evaluated the angiographic and clinical success, recurrent bleeding, and procedure-related complications.

Results

The bleeding esophageal artery directly originated from the aorta in four patients and from the left inferior phrenic artery in one patient. Although four patients had an underlying coagulopathy at the time of the TAE, angiographic and clinical success was achieved in all five patients. In addition, no procedure-related complications such as esophageal infarction were observed during this study.

Conclusion

NBCA can be an effective and feasible embolic agent in patients with active arterial esophageal bleeding, even with pre-existing coagulopathy.     

Early Results of Endovenous Ablation with a 980-nm Diode Laser for an Incompetent Vein of Giacomini

Objective

We wanted to evaluate the effectiveness of endovenous ablation of the incompetent vein of Giacomini using a 980-nm diode laser.

Materials and Methods

A total of 18 patients (18 limbs, 4%) had the incompetent vein of Giacomini. Retrograde reflux originating from the great saphenous vein was noted in sixteen limbs and paradoxical diastolic anterograde reflux from the saphenopopliteal junction was observed in two limbs. After tumescent anesthesia, laser ablation using a 980-nm wavelength laser fiber was performed under ultrasound and/or fluoroscopic guidance. Patients were evaluated clinically and with duplex ultrasound at one week and at one, three, six and twelve months after laser ablation for the technical and clinical success.

Results

In the 18 limbs, the technical success rate was 100%. Continued closure of the vein of Giacomini was seen in 18 of 18 limbs after one month, in 12 of 12 limbs after three and six months and in six of six limbs after twelve months. No recanalization of the vein and no major complications occurred.

Conclusion

Endovenous laser ablation with a 980-nm wavelength is an effective and safe procedure for treating an incompetent vein of Giacomini.     

Ethanol Sclerotherapy for the Management of Craniofacial Venous Malformations: the Interim Results

Objective

We wanted to evaluate the safety and feasibility of ethanol sclerotherapy for treating craniofacial venous malformations (CVMs).

Materials and Methods

From May 1998 to April 2007, 87 patients (40 men and 47 women; age range, 2-68 years) with CVMs underwent staged ethanol sclerotherapy (range, 1-21 sessions; median number of sessions, 2) by the direct puncture technique. Clinical follow up (range, 0-120 months; mean follow up, 35 months; median follow up, 28 months) was performed for all the patients. Therapeutic outcomes were established by evaluating the clinical outcome of the signs and symptoms in all patients, as well as the degree of devascularization, which was determined on the follow-up imaging, in 71 patients.

Results

A total of 305 procedures with the use of ethanol were performed in 87 patients. Follow-up imaging studies were performed for 71 of 87 patients. Twenty-three (32%) of the 71 patients showed excellent outcomes, 37 patients (52%) showed good outcomes and 11 patients (16%) showed poor outcomes. Ethanol sclerotherapy was considered effective for 60 patients. All the minor complications such as bulla (n = 5) healed with only wound dressing and observation. Any major complication such as skin necrosis did not develop.

Conclusion

Percutaneous ethanol sclerotherapy is an effective, safe treatment for CVMs.     

Percutaneous Radiologic Gastrostomy Using the One-Anchor Technique in Patients after Partial Gastrectomy

Objective

The purpose of our study was to assess the feasibility of performing percutaneous radiologic gastrostomy (PRG) in patients who had undergone partial gastrectomy and to evaluate factors associated with technical success.

Materials and Methods

Nineteen patients after partial gastrectomy, who were referred for PRG between April 2006 and April 2012, were retrospectively analyzed. The remnant stomach was punctured using a 21-gauge Chiba-needle. A single anchor was used for the gastropexy and a 12-Fr or 14-Fr gastrostomy tube was inserted. Data were collected regarding the technical success, procedure time, and presence of any complications. Univariable analyses were performed to determine the factors related to the technical success.

Results

Percutaneous radiologic gastrostomy was technically successful in 10 patients (53%), while a failed attempt and failure without an attempt were observed in 5 (26%) and 4 (21%) patients, respectively. Percutaneous radiologic jejunostomy was successfully performed in 9 patients who experienced technical failure. In the 10 successful PRG cases, the mean procedure time was 6.35 minutes. Major complications occurred in 2 patients, tube passage through the liver and pneumoperitonum in one and severe hemorrhage in the other. The technical success rate was higher in patients with Billroth I gastrectomy (100%, 6/6) than in patients with Billroth II gastrectomy (31%, 4/13) (p = 0.011).

Conclusion

Percutaneous radiologic gastrostomy can be successfully performed using the one-anchor technique in approximately half of the patients after partial gastrectomy.     

Alternative Techniques for Cannulation of Biliary Strictures Resistant to the 0.035" System Following Living Donor Liver Transplantation

Objective

To assess the clinical efficacy of alternative techniques for biliary stricture cannulation in patients undergoing living donor liver transplantation (LDLT), after cannulation failure with a conventional (0.035-inch guidewire) technique.

Subjects and Methods

Of 293 patients with biliary strictures after LDLT, 19 (6%) patients, 11 men and 8 women of mean age 48.5 years, had the failed cannulation of the stricture by conventional techniques. Recannulation was attempted by using two alternative methods, namely a micro-catheter set via percutaneous access and a snare (rendezvous) technique using percutaneous and endoscopic approaches.

Results

Strictures were successfully cannulated in 16 (84%) of the 19 patients. A microcatheter set was used in 12 and a snare technique in four patients. Stricture cannulation failed in the remaining three patients, who finally underwent surgical revision.

Conclusion

Most technical failures using a conventional technique for biliary stricture cannulation after LDLT can be overcome by using a microcatheter set or a snare (rendezvous) technique.     

CT-Guided Sclerotherapy for Simple Renal Cysts: Value of Ethanol Concentration Monitoring

Objective

The aim of our study was to evaluate the differences between sclerotherapy with and without ethanol concentration monitoring for the treatment of simple renal cysts.

Materials and Methods

Sixty-seven patients with 70 simple renal cysts were randomly assigned to two groups in a 12-month prospective controlled trial. One group (group A) was treated with computed tomography (CT)-guided sclerotherapy without ethanol concentration monitoring (33 patients with 35 cysts), whereas the other group (group B) had ethanol concentration monitoring (34 patients with 35 cysts) during the procedure. Treatment outcomes between the two groups were compared 12 months later with follow-up ultrasound examination.

Results

After the 12-month follow-up period, the overall success rate was 74.3% in group A and 94.3% in group B (p = 0.022). The mean cyst size before and after treatment was 8.6 ± 2.0 cm and 2.3 ± 2.9 cm, respectively, in group A, and 8.4 ± 1.7 cm and 0.8 ± 1.9 cm, respectively, in group B. The final size of the cysts in group B was significantly smaller than that in group A (p = 0.015). The likelihood of treatment with ethanol concentration monitoring being successful was approximately 16 times higher than without ethanol concentration monitoring (p = 0.026; odds ratio = 15.7; 95% confidence interval: 1.38-179.49). There were no major complications in either group.

Conclusion

Monitoring of Hounsfield units (HU) of ethanol by CT is an effective method in the treatment of simple renal cysts with ethanol sclerotherapy. The ethanol sclerotherapy procedure can be terminated at the point of clear fluid aspiration because the HU (-190) of CT scan corresponds to it.