Percutaneous removal of common bile duct stones using a modified balloon technique.

ABSTRACT: To evaluate the effectiveness of percutaneous removal of common bile duct (CBD) stones using a modified balloon technique (balloon catheter sphincteroplasty and expulsion of the stones using half-captured balloons within the sheath) in patients difficult to treat with endoscopy.Fifty patients underwent a modified balloon technique (balloon group), and 53 patients underwent CBD stone removal by the basket method (stone basket group) between 2016 and 2019. We compared the balloon and stone basket groups to evaluate the effectiveness of the modified balloon technique. Outcome variables such as demographics, technical success rates, procedural details, and complications were analyzed. Statistical analysis was performed using Student t test, Fisher exact test, or the χ2 test.The technical success rate in the balloon group was 66% (33/50) in 1 session, 32% (16/50) in 2 sessions, and 2% (1/50) in 3 sessions. That of the stone basket group was 45% (24/53) in 1 session, 38% (20/53) in 2 sessions, and 17% (9/53) in 3 sessions.The total procedure time was significantly shorter in the balloon group (29.5 ±â€Š15.1 minutes) than in the stone basket group (41.7 ±â€Š20.2 minutes) (P < .01), whereas the number of stones was higher in the balloon group than in the stone basket group (P = .03). Maximal stone size, balloon size, pancreatitis, and hospitalization stay did not show statistical differences between the 2 groups. Most complications (9 patients, balloon group; 8 patients, stone basket group) were mild and transient. Major complications occurred in one patient in the stone basket group, who experienced hemobilia due to arterial injury caused by percutaneous transhepatic biliary drainage, which was treated by endovascular embolization without mortality.The modified balloon technique is an effective and safe treatment method for CBD stone removal in patients presenting difficulties in the endoscopic approach.

Change in Portal Pressure and Clinical Outcome in Cirrhotic Patients with Gastric Varices after Plug-Assisted Retrograde Transvenous Obliteration.

Background/Aims: Plug-assisted retrograde transvenous obliteration (PARTO) is widely used to manage gastric varices with a portosystemic shunt. It is not clear whether portal pressure and the incidence of complications increase after PARTO. The aim of this study was to determine the changes in portal pressure and the associated changes in liver function, ascites, hepatic encephalopathy, and especially esophageal varix (EV) after PARTO. Methods: From March 2012 to February 2018, 54 patients who underwent PARTO were analyzed retrospectively. The parameters collected included liver function and episodes of cirrhotic complications before and at 1 and 6 months after PARTO. Results: The analysis of 54 patients showed improvement in liver function during the 6-month follow-up period (Model for End-Stage Liver Disease score: change from 11.46±4.35 to 10.33±2.96, p=0.021). Among these 54 patients, 25 patients were evaluated for their hepatic venous pressure gradient (HVPG) before and after PARTO (change from 12.52±3.83 to 14.68±5.03 mm Hg; p<0.001). Twenty-five patients with portal pressure measured before and after PARTO were evaluated for risk factors affecting liver function improvement and EV deterioration. No factor associated with portal pressure was affected by liver function improvement. Post-PARTO portal pressure was a risk factor affecting EV deterioration (HVPG-post: odds ratio, 1.341; 95% confidence interval, 1.017 to 1.767; p=0.037). Conclusions: The artificial blockade of the portosystemic shunt evidently leads to an increase in HVPG. Liver function was improved over the 6-month follow-up period. Portal pressure after PARTO was a significant risk factor for EV deterioration. Portal pressure measurement is helpful for predicting the patient's clinical outcome.

Clinical Outcome of the Visible Coil During Endoscopy After Transcatheter Arterial Embolization for Gastrointestinal Bleeding.

PURPOSE: This study was designed to evaluate the clinical outcome of the visible coil during endoscopy after transcatheter arterial embolization (TAE) for gastrointestinal bleeding. METHODS: We retrospectively reviewed the medical records of 1415 patients who underwent TAE for gastrointestinal bleeding between 2001 and 2017. Among these 1415 patients, 70 underwent TAE using coils and consecutive follow-up endoscopy. Finally, 11 patients with an extravascular coil seen on follow-up endoscopic examination were included in this study. We evaluated the underlying cause of the gastrointestinal bleeding, the technical and clinical success rates, the type of extravascular coil after TAE, and the clinical outcomes of the extravascular coil seen on follow-up endoscopic examination. RESULTS: Of the 11 patients, the most common underlying cause of gastrointestinal bleeding was a duodenal ulcer (n = 7). On angiography, the bleeding artery was most commonly found in the gastroduodenal artery (n = 6). The technical success and clinical success rates of TAE were 100% and 90.9%, respectively. The type of extravascular coil found on endoscopic examination was classified by submucosal migration (n = 6) and protrusion (n = 5). On second-look endoscopic evaluation, 10 of 11 (90.9%) patients showed healing ulceration. On the final-look endoscopic evaluation, healing ulceration without further bleeding was seen in one (9.1%) patient and scar formation was seen in ten (90.9%) patients. CONCLUSIONS: Extravascular coil after TAE for gastrointestinal bleeding is rare, and the most common underlying cause is duodenal ulcer bleeding. The extravascular coils eventually show a healing process with adequate treatment of underlying bowel pathologies.

Postpartum haemorrhage due to genital tract injury after vaginal delivery: safety and efficacy of transcatheter arterial embolisation.

OBJECTIVES: To evaluate the safety and efficacy of transcatheter arterial embolisation (TAE) managing postpartum haemorrhage associated with genital tract injury (PPH-GTI) and to determine the factors associated with clinical outcomes. METHODS: From 2002 to 2017, a retrospective analysis was performed in 60 patients (mean 31.5 years) undergoing TAE for PPH-GTI. Information regarding clinical data, angiography and embolisation details, and clinical outcomes was obtained. Univariate analyses were performed to determine the factors related to clinical outcomes. RESULTS: Technical and clinical success was achieved in 98% and 88%, respectively. Bleeding foci were observed on angiography in 56 patients (93%). The major bleeding artery was the vaginal artery (32%, 24/74), followed by the uterine artery (cervicovaginal branch) (n = 18), internal pudendal artery (n = 13), cervical artery (n = 9), inferior mesenteric artery (n = 4) and external pudendal artery (n = 3). Embolic agents were gelatin sponge particles (n = 23), gelatin sponge with permanent embolic agents (microcoils, n-butyl cyanoacrylate) (n = 34) and permanent embolic agents only (n = 3). In seven patients, bleeding control failed and was managed by repeat TAE (n = 5) or surgery (n = 2) and with eventual bleeding control in all of these patients. Univariate analysis showed that paravaginal haematoma, massive transfusion and long hospital stay were related to clinical failure. During the mean follow-up period of 33.1 months, regular menstruation resumed in 95.2% (40/42) and 14 of them became pregnant. CONCLUSIONS: TAE is safe and effective for treating PPH-GTI. Massive transfusion, paravaginal haematoma and long hospital stay were related to the failure of bleeding control. KEY POINTS: • PPH-GTI had a high detection rate of active bleeding foci on angiography. • Besides vaginal artery, inferior mesenteric and external pudendal arteries were notable bleeding foci. • Permanent embolic agents were used more than only gelatin sponge particles. • Paravaginal haematoma and massive transfusion were related to clinical failure. • TAE for PPH-GTI was safe and effective with preservation of menstrual cycles.

Transjugular Access for Endovascular Treatment of Immature Autogenous Arteriovenous Fistulae.

PURPOSE: To assess the feasibility and outcome of transjugular access for endovascular treatment of immature arteriovenous fistulae (AVFs). MATERIALS AND METHODS: Between August 2013 and January 2016, 90 patients (mean age, 64.5 y ± 12.8) underwent endovascular treatment of immature AVFs via transjugular access. The mean age of fistulae was 3.3 months ± 1.8. Total procedure time and technical and clinical success rates of endovascular procedures were assessed. Primary and secondary patency rates were calculated according to the Kaplan-Meier method, and complications were assessed. RESULTS: All patients had inflow lesions, among which 19 (21.1%) had occlusions. The juxtaanastomotic segment was the most common site (44.3%). Transjugular access was successful in 83 patients (92.2%), and 7 required additional standard or transarterial access. The mean procedure time was 36.5 minutes. Technical and clinical success rates were 98.9% and 90.5%, respectively. Mean primary and secondary patency durations were 14.3 months ± 1.7 and 31.0 months ± 0.7, respectively. Primary patency rates at 3, 6, and 12 months were 84.4%, 67.3%, and 48.8%, respectively. Secondary patency rates at 6 and 18 months were 98.6% and 95.5%, respectively. Venous rupture occurred as a result of balloon inflation in 9 patients (10%), and was managed by balloon tamponade. There were no complications related to transjugular access during a mean follow-up period of 12.6 months. CONCLUSIONS: Transjugular access for angioplasty of immature AVFs is feasible and safe. Potential problems associated with access in the outflow vein could be avoided by transjugular access.