Percutaneous endoscopy-guided gallbladder lumen-apposing metal stent retrieval, lithotripsy, and cholecystoduodenal stenting in a patient with acute cholecystitis.

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with lumen apposing metal stent (LAMS) has emerged as an effective alternative to percutaneous cholecystostomy in managing acute cholecystitis patients with contraindications to open or laparoscopic cholecystectomy. Herein, the authors describe a case of a 69-year-old male who presented to interventional radiology with sepsis due to acute calculous cholecystitis and LAMS migration into the gallbladder. After stabilizing the patient with percutaneous cholecystostomy, percutaneous cholecysto-lithotripsy/lithectomy, cholecystoduodenal stenting, and LAMS retrieval were performed.

Adverse Events After Percutaneous Transhepatic Biliary Drainage: A 10-Year Retrospective Analysis.

Purpose: To determine the adverse event (AE) rates and profiles associated with percutaneous transhepatic biliary drainage (PTBD) and to identify risk factors for their occurrence.

Materials And Methods: This single-center retrospective study included 2,310 PTBD (right-sided, 1,164; left-sided, 966; bilateral, 180) interventions for biliary obstruction (benign/malignant) in 449 patients between 2010 and 2020. Patients with percutaneous cholecystostomy alone were excluded.

Radiation Segmentectomy and Modified Radiation Lobectomy for Unresectable Early-Stage Intrahepatic Cholangiocarcinoma.

Purpose: To validate the safety and effectiveness of radiation segmentectomy (RS) and modified radiation lobectomy (mRL) in intrahepatic cholangiocarcinoma (iCCA) and to evaluate long-term outcomes in patients with unresectable, early-stage iCCA.

Materials And Methods: A single-institution, retrospective study of patients with unresectable, solitary iCCA without extrahepatic disease or vascular involvement (Stage I) treated with RS and mRL was performed. Fifteen patients met inclusion criteria (median age, 65.

Locoregional Therapies for Primary and Secondary Hepatic Malignancies.

Management of hepatic malignancies is a multidisciplinary task with the involvement of hepatologists, medical/surgical/radiation oncologists, transplant surgeons, and interventional radiologists. Patients should be selected for a specific targeted therapy after multidisciplinary consensus. Interventional oncology, with image-guided locoregional cancer therapies, can decrease systemic toxicity without compromising tumoricidal effect.

Atlas for Cholangioscopy and Cholecystoscopy: A Primer for Diagnostic and Therapeutic Endoscopy in the Biliary Tree and Gallbladder.

Percutaneous endoscopy of the biliary system (cholangioscopy) and gallbladder (cholecystoscopy) has significantly impacted diagnostic and therapeutic approaches to many diseases in interventional radiology, overcoming previous challenges related to scope size and rigidity. The current endoscopes offer enhanced maneuverability within narrow tubular structures such as bile ducts. Before endoscopy, reliance on 2D imaging modalities limited real-time visualization during percutaneous procedures.

Combined Percutaneous Transhepatic Lymphatic Embolization and Peroral Duodenal Mucosal Radiofrequency Ablation to Manage Protein-Losing Enteropathy.

Percutaneous transhepatic lymphatic embolization (PTLE) and peroral esophagogastroduodenoscopy (EGD) duodenal mucosal radiofrequency (RF) ablation were performed to manage protein-losing enteropathy (PLE) in patients with congenital heart disease. Five procedures were performed in 4 patients (3 men and 1 woman; median age, 49 years; range, 31-71 years). Transhepatic lymphangiography demonstrated abnormal periduodenal lymphatic channels.

Percutaneous Biliary Interventions via the Modified Hutson Loop in Patients with Biliary-Enteric Anastomoses: A Retrospective Study.

Purpose: This study aimed to present the institutional experience and algorithm for performing biliary interventions in liver transplant patients using the modified Hutson loop access (MHLA) and the impact of percutaneous endoscopy via the MHLA on these procedures.

Methods: Over 13 years, 201 MHLA procedures were attempted on 52 patients (45 liver transplants; 24 living and 21 deceased donors) for diagnostic (e.g.

Percutaneous Endoscopy and Image-guided Retrieval of Dropped Gallstones - A Case Series.

Background: Recurrent abscesses can happen due to dropped gallstones (DGs) after laparoscopic cholecystectomy (LC). Recognition and appropriate percutaneous endoscopy and image-guided treatment options can decrease morbidity associated with this condition.

Materials And Methods: We report a minimally invasive endoscopy and image-guided technique for retrieval of dropped gallstones in a series of 6 patients (M/F=3/3; median age: 75.

Treatment of Unicameral Bone Cysts Utilizing the Sclerograft™ Technique.

Purpose: To evaluate the Sclerograft™ procedure, which is an image-guided, minimally invasive approach of chemical sclerotherapy followed by bone grafting of unicameral bone cysts (UBC).

Materials And Methods: A retrospective evaluation from August 2018 through August 2023 was performed at a single institution on patients that underwent the Sclerograft™ procedure for UBCs. Radiographic healing was evaluated utilizing the Modified Neer Classification.

Safety and Diagnostic Efficacy of Image-Guided Biopsy of Small Renal Masses.

Introduction: Image-guided renal mass biopsy is gaining increased diagnostic acceptance, but there are limited data concerning the safety and diagnostic yield of biopsy for small renal masses (≤4 cm). This study evaluated the safety, diagnostic yield, and management after image-guided percutaneous biopsy for small renal masses.

Methods: A retrospective IRB-approved study was conducted on patients who underwent renal mass biopsy for histopathologic diagnosis at a single center from 2015 to 2021.

Adverse Events of Surgical Drain Placement: An Analysis of the NSQIP Database.

Background: Surgical site drainage is important to prevent hematoma, seroma, and abscess formation. However, the placement of drain placement also predispose patients to several postoperative complications. The aim of this study is to clarify the risk-benefit profile of surgical drain placement.

Acute Pancreatitis following Percutaneous Electrohydraulic Lithotripsy.

The gold-standard treatment of acute calculous cholecystitis is cholecystectomy. For patients not suitable for surgery, endoscopic or percutaneous techniques can be used for gallbladder decompression. The national percutaneous cholecystostomy rates have increased by 567% from 1994 to 2009*.

Percutaneous sequential closure of an Abernethy malformation: A case report.

Abernethy malformation (congenital extrahepatic portosystemic shunt [CEPS]) is rare and is characterized by an aberrant connection between the portal and systemic veins, bypassing the liver. It can have varying presentations and can lead to severe complications if left untreated. It is usually diagnosed incidentally on abdominal imaging.

Evolution of Personalized Dosimetry for Radioembolization of Hepatocellular Carcinoma.

Yttrium-90 transarterial radioembolization (TARE) has progressed from a salvage or palliative lobar or sequential bilobar regional liver therapy for patients with advanced disease to a versatile, potentially curative, and often highly selective local treatment for patients across Barcelona Clinic Liver Cancer stages. With this shift, radiation dosimetry has evolved to become more tailored to patients and target lesion(s), with treatment dose and distributions adapted for specific clinical goals (ie, palliation, bridging or downstaging to liver transplantation, converting to surgical resection candidacy, or ablative/curative intent). Data have confirmed that "personalizing" dosimetry yields real-world improvements in tumor response and overall survival while maintaining a favorable adverse event profile.

Radioembolization for Intermediate-Stage Hepatocellular Carcinoma Maintains Liver Function and Permits Systemic Therapy at Progression.

Purpose: To assess the liver function trends in patients with intermediate-stage (Barcelona Clinic Liver Cancer [BCLC] Stage B) hepatocellular carcinoma (HCC) who underwent yttrium-90 transarterial radioembolization (TARE) in response to a growing concern that liver-directed therapies negatively affect liver function and prevent patients with HCC from systemic therapy candidacy.

Materials And Methods: An HCC/TARE database (2004-2017) was retrospectively reviewed. Patients with BCLC Stage B/Child-Pugh (CP)-A HCC with laboratory test and imaging data at baseline and for at least 1 month after TARE were included.

Percutaneous Cystic Duct Interventions and Drain Internalization for Calculous Cholecystitis in Patients Ineligible for Surgery.

Purpose: To evaluate the feasibility, effectiveness, and outcomes of percutaneous cholecystostomy drain internalization in patients with calculous cholecystitis who were not surgical candidates.

Materials And Methods: Percutaneous cystic duct interventions were attempted in 17 patients (with the intent to place dual cholecystoduodenal stents) who were deemed unfit for surgery and had previously undergone percutaneous cholecystostomies for acute calculous cholecystitis. Baseline demographics, technical success, time from percutaneous cholecystostomy to internalization (dual cholecystoduodenal stent placement), stent patency duration, and adverse event rates were evaluated.

Yttrium-90 Radiation Segmentectomy in Oligometastatic Secondary Hepatic Malignancies.

Purpose: To evaluate the safety and efficacy of yttrium-90 (Y) radiation segmentectomy (RS) in the treatment of oligometastatic secondary hepatic malignancies.

Materials And Methods: This institutional review board-approved retrospective study evaluated 16 patients with oligometastatic secondary hepatic malignancies who were treated with RS. The median patient age was 61.

How Endoscopic Guidance Augments Nonvascular Image-guided Interventions.

Endoscopy can improve guidance in nonvascular procedures performed by interventional radiologists (IRs). Historically, the major limiting factors preventing the widespread use of endoscopic tools by IRs were the large diameter (>20F) and length of the endoscopes. IRs had to significantly upsize their access into vascular organs such as the kidney and liver to allow endoscope placement.

Impact of Portal Hypertension on Adverse Events after Splenic Arterial Aneurysm Embolization.

Purpose: To evaluate the outcomes of splenic artery aneurysm (SAA) embolization and compare adverse event (AE) rates after embolization in patients with and without portal hypertension (PHTN).

Materials And Methods: A retrospective review of all patients who underwent embolization of SAAs at 2 institutions was performed (34 patients from institution 1 and 7 patients from institution 2). Baseline demographic characteristics, preprocedural imaging, procedural techniques, and postprocedural outcomes were evaluated.

Preoperative portal vein recanalization-transjugular intrahepatic portosystemic shunt for chronic obliterative portal vein thrombosis: Outcomes following liver transplantation.

High-grade portal vein thrombosis (PVT) is often considered to be a technically challenging scenario for liver transplantation (LT) and in some centers a relative contraindication. This study compares patients with chronic obliterative PVT who underwent portal vein recanalization-transjugular intrahepatic portosystemic shunt (PVR-TIPS) and subsequent LT to those with partial nonocclusive PVT who underwent LT without an intervention. This institutional review board-approved study analyzed 49 patients with cirrhosis with PVT from 2000 to 2020 at our institution.