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Nadjiri J, Schachtner B, Bücker A, Heuser L, Morhard D, Mahnken AH, Hoffmann RT, Berlis A, Katoh M, Reimer P, Ingrisch M, Paprottka PM, Landwehr P. Nationwide Provision of Radiologically-guided Interventional Measures for the Supportive Treatment of Tumor Diseases in Germany - An Analysis of the DeGIR Registry Data. ROFO-FORTSCHR RONTG 2022; 194:993-1002. [PMID: 35272356 DOI: 10.1055/a-1735-3615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE In addition to direct oncologic therapy, interventional radiology plays an important supportive role in oncologic therapy primarily guided by other disciplines. These supporting measures include diagnostic punctures, drainages, biliary interventions, central venous access including port implantations, osteoplasties, pain therapies etc.). This study investigated the extent to which these radiologically guided supportive measures are available in Germany. MATERIAL AND METHODS All interventional procedures documented in the DeGIR-registry (excluding transhepatic portosystemic shunts) of the years 2018 and 2019 were recorded (DeGIR-module C). A breakdown of the documented interventions was performed based on federal states as well as 40 individual regions (administrative districts and former administrative districts). RESULTS A total of 136,328 procedures were recorded at 216 centers in DeGIR Module C in 2018 and 2019. On average, 389 cases were documented per hospital in 2018 and 394 cases in 2019; the increase per hospital from 2019 is not statistically significant but is relevant in the aggregate when new participating centers are included, with an overall increase of 10 % (6,554 more cases than the previous year). Normalized to one million inhabitants, an average of 781 procedures took place across Germany in 2018 and 860 in 2019. Districts with no registered procedures are not found for Module C.Indications for Module C interventions were mostly interdisciplinary in 2018 and 2019. In this context, the quality of outcome was very high; for the procedures drain placement, marking and biopsy the technical success was 99 %, while the complication rate was lower than 1 %. CONCLUSION The structural analysis of this work concludes that in Germany there is good nationwide availability of radiologically guided supportive measures in oncological therapy. Accordingly, the training situation for prospective interventional radiologists is good, as the distribution to centers with high experience is excellent. In addition, the overall outcome quality of radiology-guided interventions is very high. KEY POINTS · In Germany, there is good nationwide coverage of radiologically guided supportive interventions in oncological therapy.. · The training situation for prospective interventional radiologists is good, as the distribution to centers with high experience is excellent.. · The overall outcome quality of radiology-guided interventions is very high.. CITATION FORMAT · Nadjiri J, Schachtner B, Bücker A et al. Nationwide Provision of Radiologically-guided Interventional Measures for the Supportive Treatment of Tumor Diseases in Germany - An Analysis of the DeGIR Registry Data. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1735-3615.
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Affiliation(s)
- Jonathan Nadjiri
- Klinikum rechts der Isar of the Technical University of Munich, Department of Interventional Radiology, Munich
| | - Balthasar Schachtner
- Ludwig Maximilians University Munich, Department of Radiology, Munich.,Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich
| | - Arno Bücker
- Saarland University Medical Center, Clinic for Diagnostic and Interventional Radiology, Homburg
| | - Lothar Heuser
- Ruhr-Universität Bochum, Diagnostic and Interventional Radiology, Bochum
| | - Dominik Morhard
- Leopoldina Krankenhaus Schweinfurt, Radiology and Neuroradiology, Schweinfurt
| | - Andreas H Mahnken
- University Hospital Marburg, Department of Diagnostic and Interventional Radiology, Marburg.,Board member of the German Society for Interventional Radiology and Microinvasive Therapy (DeGIR), c/o Deutsche Röntgengesellschaft e.V., Berlin
| | - Ralf-Thorsten Hoffmann
- University Hospital Carl Gustav Carus, TU Dresden, Department of Radiology, Dresden.,Board member of the German Society for Interventional Radiology and Microinvasive Therapy (DeGIR), c/o Deutsche Röntgengesellschaft e.V., Berlin
| | - Ansgar Berlis
- University Hospital Augsburg, Department of Diagnostic and Interventional Radiology and Neuroradiology, Augsburg.,Board member of the German Society for Interventional Radiology and Microinvasive Therapy (DeGIR), c/o Deutsche Röntgengesellschaft e.V., Berlin
| | - Marcus Katoh
- Helios Clinic Krefeld, Department of Diagnostic and Interventional Radiology, Krefeld.,Board member of the German Society for Interventional Radiology and Microinvasive Therapy (DeGIR), c/o Deutsche Röntgengesellschaft e.V., Berlin
| | - Peter Reimer
- Städtisches Klinikum Karlsruhe, Institute for Diagnostic and Interventional Radiology, Karlsruhe.,Board member of the German Society for Interventional Radiology and Microinvasive Therapy (DeGIR), c/o Deutsche Röntgengesellschaft e.V., Berlin
| | - Michael Ingrisch
- Ludwig Maximilians University Munich, Department of Radiology, Munich
| | - Philipp M Paprottka
- Klinikum rechts der Isar of the Technical University of Munich, Department of Interventional Radiology, Munich.,Board member of the German Society for Interventional Radiology and Microinvasive Therapy (DeGIR), c/o Deutsche Röntgengesellschaft e.V., Berlin
| | - Peter Landwehr
- DIAKOVERE Henriettenstift Hannover, Clinic for Diagnostic and Interventional Radiology, Hannover.,Board member of the German Society for Interventional Radiology and Microinvasive Therapy (DeGIR), c/o Deutsche Röntgengesellschaft e.V., Berlin
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Rafiq S, Dar M, Choh N, Shaheen F, Ali S, Robbani I. Left versus right-sided percutaneous transhepatic biliary drainage in relief of malignant obstruction. MATRIX SCIENCE MEDICA 2020. [DOI: 10.4103/mtsm.mtsm_9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wybranski C, Pech M, Lux A, Ricke J, Fischbach F, Fischbach K. Hybrid Approach for Biliary Interventions Employing MRI-Guided Bile Duct Puncture with Near-Real-Time Imaging. Cardiovasc Intervent Radiol 2017; 40:884-893. [PMID: 28160096 DOI: 10.1007/s00270-017-1591-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the feasibility of a hybrid approach employing MRI-guided bile duct (BD) puncture for subsequent fluoroscopy-guided biliary interventions in patients with non-dilated (≤3 mm) or dilated BD (≥3 mm) but unfavorable conditions for ultrasonography (US)-guided BD puncture. METHODS A total of 23 hybrid interventions were performed in 21 patients. Visualization of BD and puncture needles (PN) in the interventional MR images was rated on a 5-point Likert scale by two radiologists. Technical success, planning time, BD puncture time and positioning adjustments of the PN as well as technical success of the biliary intervention and complication rate were recorded. RESULTS Visualization even of third-order non-dilated BD and PN was rated excellent by both radiologists with good to excellent interrater agreement. MRI-guided BD puncture was successful in all cases. Planning and BD puncture times were 1:36 ± 2.13 (0:16-11:07) min. and 3:58 ± 2:35 (1:11-9:32) min. Positioning adjustments of the PN was necessary in two patients. Repeated capsular puncture was not necessary in any case. All biliary interventions were completed successfully without major complications. CONCLUSION A hybrid approach which employs MRI-guided BD puncture for subsequent fluoroscopy-guided biliary intervention is feasible in clinical routine and yields high technical success in patients with non-dilated BD and/or unfavorable conditions for US-guided puncture. Excellent visualization of BD and PN in near-real-time interventional MRI allows successful cannulation of the BD.
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Affiliation(s)
- Christian Wybranski
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany
| | - Anke Lux
- Institute of Biometry and Medical Informatics, Otto-von-Guericke University Medical School, Magdeburg, Germany
| | - Jens Ricke
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany
| | - Frank Fischbach
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany
| | - Katharina Fischbach
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany
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Lucatelli P, Corradini SG, Corona M, Corradini LG, Cirelli C, Saba L, Poli E, Fanelli F, Wang H, Bezzi M, Catalano C. Risk Factors for Immediate and Delayed-Onset Fever After Percutaneous Transhepatic Biliary Drainage. Cardiovasc Intervent Radiol 2015; 39:746-755. [PMID: 26604112 DOI: 10.1007/s00270-015-1242-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/01/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To prospectively investigate the pre and intra-procedural risk factors for immediate (IF) and delayed-onset (DOF) fever development after percutaneous transhepatic biliary drainage (PTBD). METHODS Institutional review board approval and informed patient consent were obtained. Between February 2013 and February 2014, 97 afebrile patients (77 at the Sapienza University of Rome, Italy and 20 at the Sun Yat-sen University of Guangzhou, China) with benign (n = 31) and malignant (n = 66) indications for a first PTBD were prospectively enrolled. Thirty pre- and intra-procedural clinical/radiological characteristics, including the amount of contrast media injected prior to PTBD placement, were collected in relation to the development of IF (within 24 h) or DOF (after 24 h). Fever was defined as ≥37.5 °C. Binary logistic regression analysis was used to assess independent associations with IF and DOF. RESULTS Fourteen (14.4%) patients developed IF and 17 (17.5%) developed DOF. At multivariable analysis, IF was associated with pre-procedural absence of intrahepatic bile duct dilatation (OR 63.359; 95% CI 2.658-1510.055; P = 0.010) and low INR (OR 4.7 × 10(-4); 95% CI 0.000-0.376; P = 0.025), while DOF was associated with unsatisfactory biliary drainage at the end of PTBD (OR 4.571; 95% CI 1.161-17.992; P = 0.030). CONCLUSIONS The amount of contrast injected is not associated with post-PTBD fever development. Unsatisfactory biliary drainage at the end of PTBD is associated with DOF, suggesting that complete biliary tree decompression should be pursued within the first PTBD. Patients with unsatisfactory drainage and those with the absence of pre-procedural intrahepatic bile duct dilatation, which is associated with IF, require tailored post-PTBD management.
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Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Stefano Ginanni Corradini
- Gastroenterology Division, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Mario Corona
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Luca Ginanni Corradini
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Carlo Cirelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Luca Saba
- Department of Medical Imaging, Azienda Ospedaliero Universitaria (A.O.U.) of Cagliari-Polo di Monserrato, Cagliari, Italy
| | - Edoardo Poli
- Gastroenterology Division, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Fanelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Haofan Wang
- Department of Vascular Interventional Radiology of the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mario Bezzi
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Carlo Catalano
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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Surgical revision of hepaticojejunostomy strictures after pancreatectomy. Langenbecks Arch Surg 2014; 400:67-75. [PMID: 25277247 DOI: 10.1007/s00423-014-1246-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 08/21/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND After pancreatic surgery hepaticojejunostomy (HJ) stricture is a rare condition. Usually, management is conservative, while operative revision ("redo") is only rarely performed. METHODS This was an observational cohort design that analyzed the outcome of patients who had a surgical revision of HJ strictures after pancreatic surgery at a specialized pancreatic center. RESULTS During a period of 7 years from January 2004 until December 2010, 887 patients underwent pancreaticoduodenectomy (PD) or HJ. Among this patient population, 3 % (23/887) underwent a redo of the HJ secondary to stricture formation. Major symptoms of HJ strictures were recurrent cholangitis in 91 % (21/23) and jaundice in 39 % (9/23). The median time from the index operation until redo of the HJ was 16 ± 27 months. The median survival of patients with malignancy after redo of the HJ was 45 ± 67 months. Major surgical morbidity was 9 % (2/23), and mortality was 0 % (0/23). In 78 % (18/23), there were no further episodes of cholangitis after a median follow of 49 ± 73 months, while none of the patients with redo of the HJ developed a restenosis of the HJ. CONCLUSION Surgical revision (redo) of HJ strictures can be safely performed by an experienced pancreatic surgeon with a low morbidity without mortality with good long-term results.
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Herzog T, Belyaev O, Hessam S, Uhl W, Chromik AM. Management of Isolated Bile Leaks After Pancreatic Resections. J INVEST SURG 2014; 27:273-81. [DOI: 10.3109/08941939.2014.916368] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Herzog T, Belyaev O, Bakowski P, Chromik AM, Janot M, Suelberg D, Uhl W, Seelig MH. The difficult hepaticojejunostomy after pancreatic head resection: reconstruction with a T tube. Am J Surg 2013; 206:578-85. [PMID: 23906984 DOI: 10.1016/j.amjsurg.2013.01.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 01/11/2013] [Accepted: 01/24/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND After pancreatic head resection, bile leaks from a difficult hepaticojejunostomy secondary to a small or fragile common hepatic duct may be reduced by a T tube at the side of the anastomosis. METHODS A retrospective analysis of patients who underwent a difficult hepaticojejunostomy without or with a T tube was performed. RESULTS In 48% (55/114) of patients, a T tube was placed at the side of the hepaticojejunostomy; 52% (59/114) did not have a T tube. Bile leaks occurred in 12% (14/114) (9% [5/55] in patients with a T tube vs 15% [9/59] without a T tube, P = .316). Bile leaks were associated with mortality, abscess formation, hemorrhage, and sepsis. Seven percent (8/114) of patients required revisional laparotomy (2% [1/55] with a T tube vs 12% [7/59] without a T tube, P = .036). Mortality was not different between the groups. Minor T-tube-associated complications occurred in 15% (8/55) without major complications. CONCLUSIONS Augmentation of anastomosis with a T tube cannot prevent biliary leakage but does reduce the severity of bile leaks, resulting in less reoperations.
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Affiliation(s)
- Torsten Herzog
- Department of Surgery, St. Josef Hospital Bochum, University Hospital, Gudrunstr. 56, D-44791 Bochum, Germany
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Vashist YK, Yekebas EF, Gebauer F, Tachezy M, Bachmann K, König A, Kutup A, Izbicki JR. Management of the difficult duodenal stump in penetrating duodenal ulcer disease: a comparative analysis of duodenojejunostomy with "classical" stump closure (Nissen-Bsteh). Langenbecks Arch Surg 2012; 397:1243-9. [PMID: 22903877 DOI: 10.1007/s00423-012-0990-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 07/31/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Duodenal stump insufficiency after surgery for penetrating gastroduodenal ulcer is associated with substantial mortality. "Classical" technique of closing a difficult duodenal stump (Nissen-Bsteh) has, up to now, not been compared with duodenojejunostomy (DJ) in larger patient sets. This also refers to the potential benefit of a gastric and biliary diversion under such conditions. The aim of the present study was to compare classical duodenal closure (CC) with DJ and to evaluate the impact of gastric and biliary diversion on postoperative outcome after surgery for penetrating, high-risk duodenal ulcer in a matched control study. METHODS Out of 321 patients, treated for penetrating duodenal ulcer disease, the perioperative outcome of 62 DJ patients was compared with 62 patients undergoing CC matched for age, gender, biliary diversion, and the operating surgeon collective. A total of 70 patients, equally distributed between DJ and CC subsets, received temporary biliary diversion. RESULTS Overall perioperative mortality was 10.5%. However, DJ significantly reduced the mortality rate (4.8%) associated with penetrating duodenal ulcer compared to CC (16.1%, P < 0.04). The overall morbidity in DJ patients nearly equalled that in the CC group (P = 0.4). Differences in the prevalence of duodenal leakage rate between DJ (14.5%) and CC (29%) patients were of borderline significance (P = 0.05). Temporary biliary diversion was identified as a prognostic factor for closure consistency with lower duodenal leakage rates in both DJ (odds ratio 0.05, 95% confidence interval 0.005-0.42) and CC patients (odds ratio 0.2, 95% confidence interval 0.05-0.6). In contrast, gastric diversion performed in a subset of 35 DJ patients had no protective effect. CONCLUSION Duodenojejunostomy combined with temporary biliary diversion substantially improves perioperative outcome in management of penetrating duodenal ulcer.
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Affiliation(s)
- Yogesh K Vashist
- Department of Surgery, University Hospital Hamburg-Eppendorf, Martinistrasse52, 20246, Hamburg, Germany
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Gwon DI, Ko GY, Sung KB, Kim JH, Yoon HK. Percutaneous Transhepatic Treatment of Postoperative Bile Leaks: Prospective Evaluation of Retrievable Covered Stent. J Vasc Interv Radiol 2011; 22:75-83. [DOI: 10.1016/j.jvir.2010.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 10/04/2010] [Accepted: 10/09/2010] [Indexed: 12/13/2022] Open
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