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Shohei Chatani,Yozo Sato,Nozomi Okuno,Takaaki Hasegawa,Shinichi Murata,Hidekazu Yamaura,Kazuo Hara,Yasuhiro Shimizu,Yoshitaka Inaba 소화기인터벤션의학회 2021 Gastrointestinal Intervention Vol.10 No.2
Left-sided portal hypertension following pancreaticoduodenectomy (PD) with portal vein resection and splenic vein ligation may cause ectopic variceal formation, potentially resulting in life-threatening bleeding. We report of a 79-year-old male suffering from severe anemia and melena after PD. Emergency endoscopy and contrast-enhanced computed tomography (CECT) revealed ectopic varices at the anastomosis site of pancreaticojejunostomy. An interventional radiology approach was preferred over surgical and endoscopic treatment because of the poor general condition and altered anatomy. In the first procedure, percutaneous transhepatic retrograde obliteration was performed using the coaxial double balloon-occlusion technique. Although hemostasis was obtained, re-bleeding occurred two months later. CECT revealed the development of another collateral pathway and the recurrence of varices. Insufficient embolization of the afferent vein was considered the cause of recurrence. Therefore, a percutaneous transsplenic approach was used, and complete embolization of varices was achieved. When transhepatic retrograde obliteration is not effective, transsplenic antegrade obliteration can be a useful therapeutic option.
Shohei Chatani,Yozo Sato,Nozomi Okuno,Takaaki Hasegawa,Shinichi Murata,Hidekazu Yamaura,Kazuo Hara,Yasuhiro Shimizu,Yoshitaka Inaba 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.2
Left-sided portal hypertension following pancreaticoduodenectomy (PD) with portal vein resection and splenic vein ligation may cause ectopic variceal formation, potentially resulting in life-threatening bleeding. We report of a 79-year-old male suffering from severe anemia and melena after PD. Emergency endoscopy and contrast-enhanced computed tomography (CECT) revealed ectopic varices at the anastomosis site of pancreaticojejunostomy. An interventional radiology approach was preferred over surgical and endoscopic treatment because of the poor general condition and altered anatomy. In the first procedure, percutaneous transhepatic retrograde obliteration was performed using the coaxial double balloon-occlusion technique. Although hemostasis was obtained, re-bleeding occurred two months later. CECT revealed the development of another collateral pathway and the recurrence of varices. Insufficient embolization of the afferent vein was considered the cause of recurrence. Therefore, a percutaneous transsplenic approach was used, and complete embolization of varices was achieved. When transhepatic retrograde obliteration is not effective, transsplenic antegrade obliteration can be a useful therapeutic option.
Techniques for percutaneous transesophageal gastrotubing
Yozo Sato,Shohei Chatani,Takaaki Hasegawa,Shinichi Murata,Yoshitaka Inaba 소화기인터벤션의학회 2021 Gastrointestinal Intervention Vol.10 No.2
Percutaneous transesophageal gastrotubing (PTEG) procedure was developed in Japan as an alternative access route into the gastrointestinal tract, and it has been performed for patients in whom percutaneous endoscopic gastrostomy would be technically difficult to place or is contraindicated, such as in a prior gastrectomy and massive ascites. In the PTEG procedure, an indwelling tube is inserted through the cervical esophagus, which gives the patient a slight discomfort after the tube placement. Therefore, PTEG is performed not only for enteral feeding, but also for bowel decompression as a palliative care in patients with malignant gastrointestinal obstruction. Recently, several reports of PTEG from countries outside Japan indicated a high technical success rate without major complications. Furthermore, the usefulness of PTEG for bowel decompression as a palliative care was reported in prospective studies. In fact, PTEG is a technically feasible and safe procedure worldwide.
Techniques for percutaneous transesophageal gastrotubing
Yozo Sato,Shohei Chatani,Takaaki Hasegawa,Shinichi Murata,Yoshitaka Inaba 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.2
Percutaneous transesophageal gastrotubing (PTEG) procedure was developed in Japan as an alternative access route into the gastrointestinal tract, and it has been performed for patients in whom percutaneous endoscopic gastrostomy would be technically difficult to place or is contraindicated, such as in a prior gastrectomy and massive ascites. In the PTEG procedure, an indwelling tube is inserted through the cervical esophagus, which gives the patient a slight discomfort after the tube placement. Therefore, PTEG is performed not only for enteral feeding, but also for bowel decompression as a palliative care in patients with malignant gastrointestinal obstruction. Recently, several reports of PTEG from countries outside Japan indicated a high technical success rate without major complications. Furthermore, the usefulness of PTEG for bowel decompression as a palliative care was reported in prospective studies. In fact, PTEG is a technically feasible and safe procedure worldwide.
Yozo Sato,Shohei Chatani,Takaaki Hasegawa,Shinichi Murata,Takamichi Kuwahara,Kazuo Hara,Yasuhiro Shimizu,Yoshitaka Inaba 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.1
Background: Malignant afferent loop syndrome occurs after biliary reconstruction and is difficult to treat because of the complicated anatomical changes. The aim of this study was to investigate the safety and efficacy of percutaneous metallic stent placement for malignant afferent loop syndrome via the blind end of the jejunal limb after biliary reconstruction. Methods: Percutaneous metallic stent placement via the jejunal limb was performed in five male patients (median age, 68 years; range, 51–88 years) with malignant afferent loop syndrome following pancreatoduodenectomy or bile duct resection with reconstruction at our institute from June 2009 to April 2019. Reconstruction was performed using a modified Child’s method or the Roux-en-Y method, and blind end of the jejunal limb was surgically fixed to the abdominal wall. Percutaneous drainage of the afferent loop was performed via the blind end of the jejunal limb. Subsequently, percutaneous metallic stent placement was performed via the same route. Technical success, clinical success, and complications were retrospectively evaluated. Results: Percutaneous metallic stent placement via the blind end of the jejunal limb was successfully achieved in all six procedures. Additional metallic stent placement was performed due to tumor ingrowth in a patient. Drainage catheters were removed from three patients, clamped in one, and could not be removed in one. Clinical success was achieved in four patients (80%) without major complications. Conclusion: Percutaneous metallic stent placement for malignant afferent loop syndrome via the blind end of the jejunal limb after biliary reconstruction could be a safe and effective procedure.
Yozo Sato,Shohei Chatani,Takaaki Hasegawa,Shinichi Murata,Takamichi Kuwahara,Kazuo Hara,Yasuhiro Shimizu,Yoshitaka Inaba 소화기인터벤션의학회 2021 Gastrointestinal Intervention Vol.10 No.1
Background: Malignant afferent loop syndrome occurs after biliary reconstruction and is difficult to treat because of the complicated anatomical changes. The aim of this study was to investigate the safety and efficacy of percutaneous metallic stent placement for malignant afferent loop syndrome via the blind end of the jejunal limb after biliary reconstruction. Methods: Percutaneous metallic stent placement via the jejunal limb was performed in five male patients (median age, 68 years; range, 51–88 years) with malignant afferent loop syndrome following pancreatoduodenectomy or bile duct resection with reconstruction at our institute from June 2009 to April 2019. Reconstruction was performed using a modified Child’s method or the Roux-en-Y method, and blind end of the jejunal limb was surgically fixed to the abdominal wall. Percutaneous drainage of the afferent loop was performed via the blind end of the jejunal limb. Subsequently, percutaneous metallic stent placement was performed via the same route. Technical success, clinical success, and complications were retrospectively evaluated. Results: Percutaneous metallic stent placement via the blind end of the jejunal limb was successfully achieved in all six procedures. Additional metallic stent placement was performed due to tumor ingrowth in a patient. Drainage catheters were removed from three patients, clamped in one, and could not be removed in one. Clinical success was achieved in four patients (80%) without major complications. Conclusion: Percutaneous metallic stent placement for malignant afferent loop syndrome via the blind end of the jejunal limb after biliary reconstruction could be a safe and effective procedure.
Stent-graft placement for treatment of massive hemobilia caused by porto-biliary fistula
Masao Takahashi,Yozo Sato,Kazuo Hara,Nozomi Okuno,Ikuo Dejima,Shinichi Murata,Takaaki Hasegawa,Shohei Chatani,Hiroaki Onaya,Yoshitaka Inaba 소화기인터벤션의학회 2019 International journal of gastrointestinal interven Vol.8 No.4
Proton beam therapy is a type of radiation therapy and a promising modality for cancer management because it involves few adverse effects and high therapeutic efficacy. However, there are reports of acute and late complications because of normal tissue damage. Hemobilia, known as bleeding from the biliary tree, is observed in various conditions, and it can also be of iatrogenic origin such as due to percutaneous hepatobiliary interventions. In most cases, it can be managed conservatively without significant hemorrhage. However, in a few cases with massive hemobilia, further intervention is necessary. We report the successful use of a stent-graft in the portal vein to treat massive hemobilia with porto-biliary fistula that was caused by previous proton beam therapy.
Stent-graft placement for treatment of massive hemobilia caused by porto-biliary fistula
Masao Takahashi,Yozo Sato,Kazuo Hara,Nozomi Okuno,Ikuo Dejima,Shinichi Murata,Takaaki Hasegawa,Shohei Chatani,Hiroaki Onaya,Yoshitaka Inaba 소화기인터벤션의학회 2019 Gastrointestinal Intervention Vol.8 No.4
Proton beam therapy is a type of radiation therapy and a promising modality for cancer management because it involves few adverse effects and high therapeutic efficacy. However, there are reports of acute and late complications because of normal tissue damage. Hemobilia, known as bleeding from the biliary tree, is observed in various conditions, and it can also be of iatrogenic origin such as due to percutaneous hepatobiliary interventions. In most cases, it can be managed conservatively without significant hemorrhage. However, in a few cases with massive hemobilia, further intervention is necessary. We report the successful use of a stent-graft in the portal vein to treat massive hemobilia with porto-biliary fistula that was caused by previous proton beam therapy.
Risk Factors for Loosening of S2 Alar Iliac Screw: Surgical Outcomes of Adult Spinal Deformity
Iijima Yasushi,Kotani Toshiaki,Sakuma Tsuyoshi,Nakayama Keita,Akazawa Tsutomu,Kishida Shunji,Muramatsu Yuta,Sasaki Yu,Ueno Keisuke,Asada Tomoyuki,Sato Kosuke,Minami Shohei,Ohtori Seiji 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.6
Study Design: Retrospective study.Purpose: To determine the risk factors for S2 alar iliac (S2AI) screw loosening and its association with lumbosacral fusion in patients with adult spinal deformity (ASD).Overview of Literature: S2AI screws have been widely used for ASD surgery in recent years. However, no studies have analyzed the risk factors for loosening of S2AI screws and its association with lumbosacral fusion.Methods: Cases of 50 patients with ASD who underwent long spinal fusion (>9 levels) with S2AI screws were retrospectively reviewed. Loosening of S2AI screws and S1 pedicle screws and bone fusion at the level of L5–S1 at 2 years after surgery were investigated using computed tomography. In addition, risk factors for loosening of S2AI screws were determined in patients with ASD. Results: At 2 years after surgery, 33 cases (66%) of S2AI screw loosening and six cases (12%) of S1 pedicle screw loosening were observed. In 40 of 47 cases (85%), bone fusion at L5–S1 was found. Pseudarthrosis at L5–S1 was not significantly associated with S2AI screw loosening (19.3% vs. 6.3%, <i>p</i>=0.23), but significantly higher in patients with S1 screw loosening (83.3% vs. 4.9%, <i>p</i><0.001). On multivariate logistic regression analyses, high upper instrumented vertebra (UIV) level (T5 or above) (odds ratio [OR], 4.4; 95% confidence interval [CI], 1.0–18.6; <i>p</i>=0.045) and obesity (OR, 11.4; 95% CI, 1.2–107.2; <i>p</i>=0.033) were independent risk factors for S2AI screw loosening.Conclusions: High UIV level (T5 or above) and obesity were independent risk factors for S2AI screw loosening in patients with lumbosacral fixation in surgery for ASD. The incidence of lumbosacral fusion is associated with S1 screw loosening, but not S2AI screw loosening.