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Retrospective Review of percutaneous radiologic gastrostomy placement in patients with amyotrophic lateral sclerosis
S42
’
Sunday
Scientific Session
3
SUNDAY: Scientific Sessions
Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; 4Asan Medical Hospital, Seoul, Seoul; 5Asan Medical Center, Seoul-City, Republic of Korea; 6University of Ulsan College of Medicine, Seoul, Korea Purpose: To compare the outcomes of fluoroscopic stent placement (FSP) and endoscopic stent placement (ESP) in patients with malignant gastric outlet obstruction (GOO). Materials: A retrospective study was performed in 306 patients who were treated either by FSP (n ¼ 125) or ESP (n ¼ 181). The outcomes were assessed the following variables: success rates; procedure time; complications; re-intervention; stent patency; and survival. Results: A total of 193 patients met our inclusion criteria, including 125 patients in FSP and 68 patients in ESP. The technical and clinical outcomes did not differ between the two groups. The stent migration was higher in the ESP group than in the FSP group (P ¼ 0.002). In the ESP group, the use of the straight end of the stent and chemotherapy were associated with an increase in stent migration. The stent collapse was lower in the ESP group than in the FSP group (P ¼ 0.021). The six-month stent patency was higher in the ESP group than in the FSP group (P ¼ 0.044). Conclusions: Despite the significant difference in the stent migration and collapse rates, the technical and clinical outcomes were similar between the two groups for the palliation of malignant GOO.
3:00 PM
Abstract No. 84
Incidence and outcomes of major bleeding complications following transjugular liver biopsy: a single center review of 1600 cases D. Biederman1, B. Marinelli2, J. Titano2, N. Tabori1, E. Kim3, R. Patel3, F. Nowakowski1, R. Lookstein4, A. Fischman2; 1N/A, New York, NY; 2Icahn School of Medicine at Mount Sinai, New York, NY; 3Mount Sinai Medical Center, New York, NY; 4Mount Sinai Hospital, New York, NY Purpose: Transjuglar liver biopsy (TJLB) is an alternative to percutaneous liver biopsy commonly used in hypocoaguable patients. In this study we evaluated the incidence and outcomes of major bleeding complications secondary to TJLB. Materials: A single center retrospective review of all TJLBs was performed. Patients with a transhepatic portosystemic shunt (TIPS) placed at the time of TJLB were excluded. Complications were defined according to the Society of Interventional Radiology criteria. Major bleeding complications were identified by reviewing all cross sectional (CT and MR) exams performed within 10 days after TJLB. The primary outcome variable was development of a major bleeding complication. Secondary outcome variables included need for secondary intervention, and procedure related mortality. Results: From 1/2002 to 12/2014 a total of 1613 consecutive TJLB were performed. Of these total, 1576 procedures met the study inclusion criteria. A total of 157 cross-sectional imaging studies in the 10-day post procedural period were reviewed. Seven major bleeding complications (0.4 %) were identified, including
’
JVIR
intraperitoneal hemorrhage (n ¼ 5) and large hematoma (n ¼ 2). Active extravasation was identified in 3 cases, all of which required re-intervention. There were 3 (0.2 %) procedure related mortalities. Active bleeding at the time of follow-up imaging (p ¼ 0.061) was associated with a trend towards increased mortality risk. Conclusions: Major bleeding complications post-TJLB are very rare but associated with a significant mortality risk.
3:45 PM
Abstract No. 85
Three year results with a novel bariatric device S. Solomon1, E. Noren2, H. Forssell2; 1New York, NY; 2 Blekinge County Hospital, Blekinge, Karlskrona Purpose: Obesity is a major public health problem with few effective treatment options. The purpose of this prospective study was to evaluate weight loss efficacy and safety of a new device for treating obesity, the AspireAssist® Aspiration Therapy System (Aspire Bariatrics, King of Prussia, PA). Materials: From July 2012 through September 2012, 25 obese subjects with a mean BMI of 39.8 þ 4.3 kg/m2 were enrolled in a pilot study. This was an Ethics Committee approved, single center study performed at Blekinge County Hospital, Karlskrona, Sweden. The AspireAssist® Aspiration Therapy System (AspireAssist) comprises a percutaneous gastrostomy tube (Atube) through which patients aspirate a portion of ingested meals from the stomach and an accessory siphon device that facilitates aspiration. The study was planned as a one year study, but 12 subjects wished to keep their device for up to 3 years. Results: Of 25 subjects, 22 subjects completed one year, 15 subjects 2 years, and 12 subjects completed 3 years. The mean weight loss for the 12 patients who completed 3 years was 26 kg with an excess weight loss (EWL) of mean 58%. On an Intent to treat basis, using last observation carry-forward, mean weight loss at the end of year 1,2, 3 was 48% (19 kg), 46% (18 kg), and 45% EWL (19 kg), respectively. Conclusions: The AspireAssist Aspiration Therapy System enables a low risk, reversible weight loss therapy with results approaching that of bariatric surgery.
4:03 PM
Abstract No. 86
Retrospective Review of percutaneous radiologic gastrostomy placement in patients with amyotrophic lateral sclerosis R. Fricke1, R. Pahls2, R. Li3, J. Meek3; 1University of Arkansas for Medical Sciences, Little Rock, AR; 2UAMS, Little Rock, AR; 3N/A, Little Rock, AR Purpose: Gastrostomy placement is indicated in ALS patients with malnutrition and weight loss, as these have been shown to be negative prognostic indicators (1). Radiologic gastrostomy placement carries the benefit of not requiring intubation and ventilator support necessary in endoscopic techniques. The purpose of this study is to retrospectively evaluate complication rate of percutaneous radiologic gastrostomy placement in patients with ALS. Materials: Twenty five patients (12 men and 13 women; mean age 66) with ALS received PRG placement between
JVIR
’
Scientific Session
Sunday
’
S43
Technical success rate was 94%. The indications for gastrostomy placement were malnutrition related to gastric bypass in 18 cases (55%), delayed gastric remnant emptying/ biliopancreatic limb obstruction in 8 cases (24%), and malnutrition due to illness unrelated to gastric bypass in 7 cases (21%). The mean duration of gastrostomy access was 117 days with a range of 3 to 698 days. Within the delayed gastric remnant emptying/biliopancreatic limb obstruction group, symptoms resolved in 6 patients while 2 patients underwent subsequent surgery for lysis of adhesions. There were 4 major complications: local cellulitis, leak with peritonitis requiring surgery, delayed gastric bleeding requiring transfusion, and unrelenting pain necessitating tube removal and surgical gastrostomy. There were no procedure related deaths. Conclusions: Percutaneous gastric remnant gastrostomy is a safe procedure with a high technical success rate. This technique allows most patients to avoid a more invasive surgical procedure for establishing enteral nutrition or decompression.
References
R. Zener, K. Wanis, A. Istl, J. Kachura, S. Latosinsky, D. Wiseman; London Health Sciences Centre, London, ON
1. Desport JC, et al. Nutritional status is a prognostic factor for survival in ALS patients. Neurology 1999;53(5):1059-1064. 2. Sacks D, et al. Soctiey of Inteventional Radiology clinical practice guidelines. JVIR 2003; 14:S199-202. 3. Blondet A, et al. Radiologic versus Endoscopic Placement of Percutaneous Gastrostomy in Amyotrophic Lateral Sclerosis: Multivariate Analysis of Tolerance, Efficacy, and Survival. J Vasc Interv Radiol 2010;21:527-533.
4:12 PM
Abstract No. 87
Percutaneous gastric remnant gastrostomy following roux-en-Y gastric bypass surgery: a single tertiary center’s twelve year experience S. Shaikh1, J. Stenz2, D. McVinnie3, J. Morrison4, T. Getzen5, A. Carlin6, F. Mir7; 1Henry Ford Hospital, Dearborn, MI; 2N/A, Royal Oak, MI; 3HENRY FORD HOSPITAL, Windsor, ON; 4N/A, Portland, OR; 5N/A, Ann Arbor, MI; 6Henry Ford Hospital, Detroit, MI; 7N/A, Traverse City, MI Purpose: To review the indications, access techniques, and outcomes for percutaneous gastric remnant gastrostomy performed in patients following Roux-en-Y gastric bypass surgery. Materials: The medical records of all Roux-en-Y gastric bypass patients who underwent a percutaneous gastric remnant gastrostomy procedure between April 2003 (first identified patient) and September 2015 were reviewed. Indications, techniques for obtaining access, technical success, complications, and clinical course were reviewed. Complications were recorded per Society of Interventional Radiology practice guidelines. Institutional review board approval was obtained. Results: A total of 31 patients were identified in which 33 procedures were attempted. The mean age was 51 years and 24 patients were female. Access was obtained using fluoroscopy, ultrasound and fluoroscopy, or computed tomography.
4:21 PM
Abstract No. 88
Complication rates for percutaneous enteral tube insertion: how are we doing?
Purpose: 1). To establish the 30-day mortality and complication rates of percutaneous radiologic gastrojejunostomy and gastrostomy in adult patients at our centre. 2). To compare our complication rates with those reported in the literature (mortality: up to 1.9%; major: 1.4-5.9%, minor: 1.345%) [1,2,3]. Materials: All consecutively inserted percutaneous fluoroscopically guided gastrojejunostomy (GJ) and gastrostomy (G) tubes in adult patients, by interventional radiology in a 3-year period (2011-2014) at a single academic tertiary care centre, were retrospectively reviewed. Procedure-related mortality was determined. Complications within the 30-day postprocedure period were classified as major or minor based on the Society of Interventional Radiology Standards of Practice. Mortality and complication rates between GJ and G groups were compared with Fisher’s Exact Test (Po.05). Results: 559 percutaneous enteral tubes were placed (479 GJ and 86G). 69 complications occurred: 60 minor and 9 major. The 30-day complication rate for percutaneous enteral tube insertion was 12.3% overall, 10.7% for minor, and 1.6% for major complications. The overall 30-day complication rate was significantly higher (13.5% vs 5.8%, P¼.049). for the GJ group compared to the G group. There was a trend toward a higher 30-day minor complication rate (11.8% vs 4.7%, P¼.057) in the GJ group compared to the G group. Four procedure-related deaths occurred from major complications, all secondary to intra-abdominal sepsis, resulting in an overall procedurerelated mortality rate of 0.7%. No significant difference was found in the major complication rate (1.7% vs 1.2%, P¼1.0), or in procedure-related mortality rate (0.6% vs. 1.2%, P¼.49) between GJ and G groups, respectively. Conclusions: The major complication and procedure-related mortality rates from percutaneous fluroscopically guided
SUNDAY: Scientific Sessions
June 2014 and September 2015. A retrospective review of technique and peri-procedural complications was performed for each patient. Major and minor complications were stratified based on the SIR reporting standards (2). Insufflation of the stomach was achieved under fluoroscopic guidance using one of three methods: nasogastric tube; direct stick with a 21G Chiba needle; or Effervescent Granules with subsequent direct stick. Results: PRG was successful in 88% of patients. PRG was not attempted in 3 patients due to an elevated left hemidiaphragm or prior surgery. Minor complications were seen in 27.2% (leakage (4.5%), granulation tissue (9.1%), and local infection (13.6%)), lower than reported PRG rates of 32% (3). One major complication occurred (4.5%), which is lower than reported rates (14.3%) in endoscopic gastrostomy placement (3). This patient developed aspiration pneumonia and respiratory distress 5 days post-operatively and required ICU admission. Direct stick (33.3%) and effervescent (25%) techniques had lower minor complication rates than NGT insufflation (33.3%). Conclusions: The presented techniques for PRG placement are safe and effective for enteral nutrition in ALS patients with the added benefit of not requiring intubation or ventilatory support.
’
Sunday
Scientific Session
3
SUNDAY: Scientific Sessions
Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; 4Asan Medical Hospital, Seoul, Seoul; 5Asan Medical Center, Seoul-City, Republic of Korea; 6University of Ulsan College of Medicine, Seoul, Korea Purpose: To compare the outcomes of fluoroscopic stent placement (FSP) and endoscopic stent placement (ESP) in patients with malignant gastric outlet obstruction (GOO). Materials: A retrospective study was performed in 306 patients who were treated either by FSP (n ¼ 125) or ESP (n ¼ 181). The outcomes were assessed the following variables: success rates; procedure time; complications; re-intervention; stent patency; and survival. Results: A total of 193 patients met our inclusion criteria, including 125 patients in FSP and 68 patients in ESP. The technical and clinical outcomes did not differ between the two groups. The stent migration was higher in the ESP group than in the FSP group (P ¼ 0.002). In the ESP group, the use of the straight end of the stent and chemotherapy were associated with an increase in stent migration. The stent collapse was lower in the ESP group than in the FSP group (P ¼ 0.021). The six-month stent patency was higher in the ESP group than in the FSP group (P ¼ 0.044). Conclusions: Despite the significant difference in the stent migration and collapse rates, the technical and clinical outcomes were similar between the two groups for the palliation of malignant GOO.
3:00 PM
Abstract No. 84
Incidence and outcomes of major bleeding complications following transjugular liver biopsy: a single center review of 1600 cases D. Biederman1, B. Marinelli2, J. Titano2, N. Tabori1, E. Kim3, R. Patel3, F. Nowakowski1, R. Lookstein4, A. Fischman2; 1N/A, New York, NY; 2Icahn School of Medicine at Mount Sinai, New York, NY; 3Mount Sinai Medical Center, New York, NY; 4Mount Sinai Hospital, New York, NY Purpose: Transjuglar liver biopsy (TJLB) is an alternative to percutaneous liver biopsy commonly used in hypocoaguable patients. In this study we evaluated the incidence and outcomes of major bleeding complications secondary to TJLB. Materials: A single center retrospective review of all TJLBs was performed. Patients with a transhepatic portosystemic shunt (TIPS) placed at the time of TJLB were excluded. Complications were defined according to the Society of Interventional Radiology criteria. Major bleeding complications were identified by reviewing all cross sectional (CT and MR) exams performed within 10 days after TJLB. The primary outcome variable was development of a major bleeding complication. Secondary outcome variables included need for secondary intervention, and procedure related mortality. Results: From 1/2002 to 12/2014 a total of 1613 consecutive TJLB were performed. Of these total, 1576 procedures met the study inclusion criteria. A total of 157 cross-sectional imaging studies in the 10-day post procedural period were reviewed. Seven major bleeding complications (0.4 %) were identified, including
’
JVIR
intraperitoneal hemorrhage (n ¼ 5) and large hematoma (n ¼ 2). Active extravasation was identified in 3 cases, all of which required re-intervention. There were 3 (0.2 %) procedure related mortalities. Active bleeding at the time of follow-up imaging (p ¼ 0.061) was associated with a trend towards increased mortality risk. Conclusions: Major bleeding complications post-TJLB are very rare but associated with a significant mortality risk.
3:45 PM
Abstract No. 85
Three year results with a novel bariatric device S. Solomon1, E. Noren2, H. Forssell2; 1New York, NY; 2 Blekinge County Hospital, Blekinge, Karlskrona Purpose: Obesity is a major public health problem with few effective treatment options. The purpose of this prospective study was to evaluate weight loss efficacy and safety of a new device for treating obesity, the AspireAssist® Aspiration Therapy System (Aspire Bariatrics, King of Prussia, PA). Materials: From July 2012 through September 2012, 25 obese subjects with a mean BMI of 39.8 þ 4.3 kg/m2 were enrolled in a pilot study. This was an Ethics Committee approved, single center study performed at Blekinge County Hospital, Karlskrona, Sweden. The AspireAssist® Aspiration Therapy System (AspireAssist) comprises a percutaneous gastrostomy tube (Atube) through which patients aspirate a portion of ingested meals from the stomach and an accessory siphon device that facilitates aspiration. The study was planned as a one year study, but 12 subjects wished to keep their device for up to 3 years. Results: Of 25 subjects, 22 subjects completed one year, 15 subjects 2 years, and 12 subjects completed 3 years. The mean weight loss for the 12 patients who completed 3 years was 26 kg with an excess weight loss (EWL) of mean 58%. On an Intent to treat basis, using last observation carry-forward, mean weight loss at the end of year 1,2, 3 was 48% (19 kg), 46% (18 kg), and 45% EWL (19 kg), respectively. Conclusions: The AspireAssist Aspiration Therapy System enables a low risk, reversible weight loss therapy with results approaching that of bariatric surgery.
4:03 PM
Abstract No. 86
Retrospective Review of percutaneous radiologic gastrostomy placement in patients with amyotrophic lateral sclerosis R. Fricke1, R. Pahls2, R. Li3, J. Meek3; 1University of Arkansas for Medical Sciences, Little Rock, AR; 2UAMS, Little Rock, AR; 3N/A, Little Rock, AR Purpose: Gastrostomy placement is indicated in ALS patients with malnutrition and weight loss, as these have been shown to be negative prognostic indicators (1). Radiologic gastrostomy placement carries the benefit of not requiring intubation and ventilator support necessary in endoscopic techniques. The purpose of this study is to retrospectively evaluate complication rate of percutaneous radiologic gastrostomy placement in patients with ALS. Materials: Twenty five patients (12 men and 13 women; mean age 66) with ALS received PRG placement between
JVIR
’
Scientific Session
Sunday
’
S43
Technical success rate was 94%. The indications for gastrostomy placement were malnutrition related to gastric bypass in 18 cases (55%), delayed gastric remnant emptying/ biliopancreatic limb obstruction in 8 cases (24%), and malnutrition due to illness unrelated to gastric bypass in 7 cases (21%). The mean duration of gastrostomy access was 117 days with a range of 3 to 698 days. Within the delayed gastric remnant emptying/biliopancreatic limb obstruction group, symptoms resolved in 6 patients while 2 patients underwent subsequent surgery for lysis of adhesions. There were 4 major complications: local cellulitis, leak with peritonitis requiring surgery, delayed gastric bleeding requiring transfusion, and unrelenting pain necessitating tube removal and surgical gastrostomy. There were no procedure related deaths. Conclusions: Percutaneous gastric remnant gastrostomy is a safe procedure with a high technical success rate. This technique allows most patients to avoid a more invasive surgical procedure for establishing enteral nutrition or decompression.
References
R. Zener, K. Wanis, A. Istl, J. Kachura, S. Latosinsky, D. Wiseman; London Health Sciences Centre, London, ON
1. Desport JC, et al. Nutritional status is a prognostic factor for survival in ALS patients. Neurology 1999;53(5):1059-1064. 2. Sacks D, et al. Soctiey of Inteventional Radiology clinical practice guidelines. JVIR 2003; 14:S199-202. 3. Blondet A, et al. Radiologic versus Endoscopic Placement of Percutaneous Gastrostomy in Amyotrophic Lateral Sclerosis: Multivariate Analysis of Tolerance, Efficacy, and Survival. J Vasc Interv Radiol 2010;21:527-533.
4:12 PM
Abstract No. 87
Percutaneous gastric remnant gastrostomy following roux-en-Y gastric bypass surgery: a single tertiary center’s twelve year experience S. Shaikh1, J. Stenz2, D. McVinnie3, J. Morrison4, T. Getzen5, A. Carlin6, F. Mir7; 1Henry Ford Hospital, Dearborn, MI; 2N/A, Royal Oak, MI; 3HENRY FORD HOSPITAL, Windsor, ON; 4N/A, Portland, OR; 5N/A, Ann Arbor, MI; 6Henry Ford Hospital, Detroit, MI; 7N/A, Traverse City, MI Purpose: To review the indications, access techniques, and outcomes for percutaneous gastric remnant gastrostomy performed in patients following Roux-en-Y gastric bypass surgery. Materials: The medical records of all Roux-en-Y gastric bypass patients who underwent a percutaneous gastric remnant gastrostomy procedure between April 2003 (first identified patient) and September 2015 were reviewed. Indications, techniques for obtaining access, technical success, complications, and clinical course were reviewed. Complications were recorded per Society of Interventional Radiology practice guidelines. Institutional review board approval was obtained. Results: A total of 31 patients were identified in which 33 procedures were attempted. The mean age was 51 years and 24 patients were female. Access was obtained using fluoroscopy, ultrasound and fluoroscopy, or computed tomography.
4:21 PM
Abstract No. 88
Complication rates for percutaneous enteral tube insertion: how are we doing?
Purpose: 1). To establish the 30-day mortality and complication rates of percutaneous radiologic gastrojejunostomy and gastrostomy in adult patients at our centre. 2). To compare our complication rates with those reported in the literature (mortality: up to 1.9%; major: 1.4-5.9%, minor: 1.345%) [1,2,3]. Materials: All consecutively inserted percutaneous fluoroscopically guided gastrojejunostomy (GJ) and gastrostomy (G) tubes in adult patients, by interventional radiology in a 3-year period (2011-2014) at a single academic tertiary care centre, were retrospectively reviewed. Procedure-related mortality was determined. Complications within the 30-day postprocedure period were classified as major or minor based on the Society of Interventional Radiology Standards of Practice. Mortality and complication rates between GJ and G groups were compared with Fisher’s Exact Test (Po.05). Results: 559 percutaneous enteral tubes were placed (479 GJ and 86G). 69 complications occurred: 60 minor and 9 major. The 30-day complication rate for percutaneous enteral tube insertion was 12.3% overall, 10.7% for minor, and 1.6% for major complications. The overall 30-day complication rate was significantly higher (13.5% vs 5.8%, P¼.049). for the GJ group compared to the G group. There was a trend toward a higher 30-day minor complication rate (11.8% vs 4.7%, P¼.057) in the GJ group compared to the G group. Four procedure-related deaths occurred from major complications, all secondary to intra-abdominal sepsis, resulting in an overall procedurerelated mortality rate of 0.7%. No significant difference was found in the major complication rate (1.7% vs 1.2%, P¼1.0), or in procedure-related mortality rate (0.6% vs. 1.2%, P¼.49) between GJ and G groups, respectively. Conclusions: The major complication and procedure-related mortality rates from percutaneous fluroscopically guided
SUNDAY: Scientific Sessions
June 2014 and September 2015. A retrospective review of technique and peri-procedural complications was performed for each patient. Major and minor complications were stratified based on the SIR reporting standards (2). Insufflation of the stomach was achieved under fluoroscopic guidance using one of three methods: nasogastric tube; direct stick with a 21G Chiba needle; or Effervescent Granules with subsequent direct stick. Results: PRG was successful in 88% of patients. PRG was not attempted in 3 patients due to an elevated left hemidiaphragm or prior surgery. Minor complications were seen in 27.2% (leakage (4.5%), granulation tissue (9.1%), and local infection (13.6%)), lower than reported PRG rates of 32% (3). One major complication occurred (4.5%), which is lower than reported rates (14.3%) in endoscopic gastrostomy placement (3). This patient developed aspiration pneumonia and respiratory distress 5 days post-operatively and required ICU admission. Direct stick (33.3%) and effervescent (25%) techniques had lower minor complication rates than NGT insufflation (33.3%). Conclusions: The presented techniques for PRG placement are safe and effective for enteral nutrition in ALS patients with the added benefit of not requiring intubation or ventilatory support.