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Koizumi E, Goto O, Nakagome S, Habu T, Ishikawa Y, Kirita K, Noda H, Higuchi K, Onda T, Akimoto T, Omori J, Akimoto N, Iwakiri K. Technical outcomes and postprocedural courses of mucosal incision-assisted biopsy for possible gastric gastrointestinal stromal tumors: A series of 48 cases (with video). DEN Open 2024; 4:e264. [PMID: 37359151 PMCID: PMC10288069 DOI: 10.1002/deo2.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
Objective Mucosal incision-assisted biopsy (MIAB) has been introduced as an alternative to endoscopic ultrasound-guided fine needle aspiration for tissue sampling of subepithelial lesions. However, there have been few reports on MIAB, and the evidence is lacking, particularly in small lesions. In this case series, we investigated the technical outcomes and postprocedural influences of MIAB for gastric subepithelial lesions 10 mm or greater in size. Methods We retrospectively reviewed cases with the intraluminal growth type of possible gastrointestinal stromal tumors, in which MIAB was performed at a single institution between October 2020 and August 2022. Technical success, adverse events, and clinical courses following the procedure were evaluated. Results In 48 MIAB cases with a median tumor diameter of 16 mm, the success rate of tissue sampling and the diagnostic rate were 96% and 92%, respectively. Two biopsies were considered sufficient for making the definitive diagnosis. Postoperative bleeding occurred in one case (2%). In 24 cases, surgery has performed a median of two months after MIAB, and no unfavorable findings caused by MIAB were seen intraoperatively. Finally, 23 cases were histologically diagnosed as gastrointestinal stromal tumors, and no patients who underwent MIAB experienced recurrence or metastasis during a median observation period of 13 months. Conclusions The data indicated that MIAB appears feasible, safe, and useful for histological diagnosis of gastric intraluminal growth types of possible gastrointestinal stromal tumors, even those of a small size. Postprocedural clinical effects were considered negligible.
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Affiliation(s)
- Eriko Koizumi
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Osamu Goto
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
- Division of EndoscopyNippon Medical School HospitalTokyoJapan
| | - Shun Nakagome
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Tsugumi Habu
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Yumiko Ishikawa
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Kumiko Kirita
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Hiroto Noda
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Kazutoshi Higuchi
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Takeshi Onda
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Teppei Akimoto
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Jun Omori
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Naohiko Akimoto
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Katsuhiko Iwakiri
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
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Stahl R, Seidensticker M, Arbogast H, Kuppinger D, Greif V, Crispin A, D’Anastasi M, Pedersen V, Forbrig R, Liebig T, Rutetzki T, Trumm CG. Technical and Clinical Outcome of Low-Milliampere CT Fluoroscopy-Guided Percutaneous Drainage Placement in Abdominal Fluid Collections after Liver Transplantation: A 16-Year Retrospective Analysis of 50 Consecutive Patients. Diagnostics (Basel) 2024; 14:353. [PMID: 38396392 PMCID: PMC10887879 DOI: 10.3390/diagnostics14040353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
PURPOSE Evaluation of the effectiveness of CT-guided drainage (CTD) placement in managing symptomatic postoperative fluid collections in liver transplant patients. The assessment included technical success, clinical outcomes, and the occurrence of complications during the peri-interventional period. METHODS Analysis spanned the years 2005 to 2020 and involved 91 drain placement sessions in 50 patients using percutaneous transabdominal or transhepatic access. Criteria for technical success (TS) included (a) achieving adequate drainage of the fluid collection and (b) the absence of peri-interventional complications necessitating minor or prolonged hospitalization. Clinical success (CS) was characterized by (a) a reduction or normalization of inflammatory blood parameters within 30 days after CTD placement and (b) the absence of a need for surgical revision within 60 days after the intervention. Inflammatory markers in terms of C-reactive protein (CRP), leukocyte count and interleukin-6, were evaluated. The dose length product (DLP) for various intervention steps was calculated. RESULTS The TS rate was 93.4%. CS rates were 64.3% for CRP, 77.8% for leukocytes, and 54.5% for interleukin-6. Median time until successful decrease was 5.0 days for CRP and 3.0 days for leukocytes and interleukin-6. Surgical revision was not necessary in 94.0% of the cases. During the second half of the observation period, there was a trend (p = 0.328) towards a lower DLP for the entire intervention procedure (median: years 2013 to 2020: 623.0 mGy·cm vs. years 2005 to 2012: 811.5 mGy·cm). DLP for the CT fluoroscopy component was significantly (p = 0.001) lower in the later period (median: years 2013 to 2020: 31.0 mGy·cm vs. years 2005 to 2012: 80.5 mGy·cm). CONCLUSIONS The TS rate of CT-guided drainage (CTD) placement was notably high. The CS rate ranged from fair to good. The reduction in radiation exposure over time can be attributed to advancements in CT technology and the growing expertise of interventional radiologists.
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Affiliation(s)
- Robert Stahl
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (T.R.); (C.G.T.)
| | - Max Seidensticker
- Department of Radiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.S.); (V.G.)
| | - Helmut Arbogast
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (H.A.); (D.K.)
| | - David Kuppinger
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (H.A.); (D.K.)
| | - Veronika Greif
- Department of Radiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.S.); (V.G.)
| | - Alexander Crispin
- IBE—Institute for Medical Information Processing, Biometry and Epidemiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany;
| | - Melvin D’Anastasi
- Medical Imaging Department, Mater Dei Hospital, University of Malta, MSD 2090 Msida, Malta;
| | - Vera Pedersen
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany;
| | - Robert Forbrig
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (T.R.); (C.G.T.)
| | - Thomas Liebig
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (T.R.); (C.G.T.)
| | - Tim Rutetzki
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (T.R.); (C.G.T.)
| | - Christoph G. Trumm
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (T.R.); (C.G.T.)
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Stahl R, Seidensticker M, de Figueiredo GN, Pedersen V, Crispin A, Forbrig R, Ozpeynirci Y, Liebig T, D’Anastasi M, Hackner D, Trumm CG. Low-Dose CT Fluoroscopy-Guided Drainage of Deep Pelvic Fluid Collections after Colorectal Cancer Surgery: Technical Success, Clinical Outcome and Safety in 40 Patients. Diagnostics (Basel) 2023; 13:diagnostics13040711. [PMID: 36832199 PMCID: PMC9955776 DOI: 10.3390/diagnostics13040711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE To assess the technical (TS) and clinical success (CS) of CT fluoroscopy-guided drainage (CTD) in patients with symptomatic deep pelvic fluid collections following colorectal surgery. METHODS A retrospective analysis (years 2005 to 2020) comprised 43 drain placements in 40 patients undergoing low-dose (10-20 mA tube current) quick-check CTD using a percutaneous transgluteal (n = 39) or transperineal (n = 1) access. TS was defined as sufficient drainage of the fluid collection by ≥50% and the absence of complications according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE). CS comprised the marked reduction of elevated laboratory inflammation parameters by ≥50% under minimally invasive combination therapy (i.v. broad-spectrum antibiotics, drainage) within 30 days after intervention and no surgical revision related to the intervention required. RESULTS TS was gained in 93.0%. CS was obtained in 83.3% for C-reactive Protein and in 78.6% for Leukocytes. In five patients (12.5%), a reoperation due to an unfavorable clinical outcome was necessary. Total dose length product (DLP) tended to be lower in the second half of the observation period (median: years 2013 to 2020: 544.0 mGy*cm vs. years 2005 to 2012: 735.5 mGy*cm) and was significantly lower for the CT fluoroscopy part (median: years 2013 to 2020: 47.0 mGy*cm vs. years 2005 to 2012: 85.0 mGy*cm). CONCLUSIONS Given a minor proportion of patients requiring surgical revision due to anastomotic leakage, the CTD of deep pelvic fluid collections is safe and provides an excellent technical and clinical outcome. The reduction of radiation exposition over time can be achieved by both the ongoing development of CT technology and the increased level of interventional radiology (IR) expertise.
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Affiliation(s)
- Robert Stahl
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
- Correspondence: ; Tel.: +49-89-4400-74629
| | - Max Seidensticker
- Department of Radiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Giovanna Negrão de Figueiredo
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstr. 10, 8091 Zurich, Switzerland
| | - Vera Pedersen
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Alexander Crispin
- IBE—Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Robert Forbrig
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Yigit Ozpeynirci
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Thomas Liebig
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Melvin D’Anastasi
- Department of Radiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
- Medical Imaging Department, Mater Dei Hospital, University of Malta, MSD 2090 Msida, Malta
| | - Danilo Hackner
- Department of General and Visceral Surgery, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Christoph G. Trumm
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
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Strasding M, Hicklin SP, Todorovic A, Fehmer V, Mojon P, Sailer I. A multicenter randomized controlled clinical pilot study of buccally micro-veneered lithium-disilicate and zirconia crowns supported by titanium base abutments: 1-year outcomes. Clin Oral Implants Res 2023; 34:56-65. [PMID: 36321877 PMCID: PMC10098475 DOI: 10.1111/clr.14018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/07/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To investigate survival rates, technical and biologic outcomes of buccally micro-veneered all-ceramic single implant crowns. MATERIAL AND METHODS Sixty subjects randomly received immediately or early placed implants. Crowns out of lithium-disilicate (n = 30) and zirconia-ceramic (n = 30) were bonded to titanium-base-abutments. Restorations were inspected at baseline (BL) and during follow-up visits (6, 12 months). Technical and biologic parameters were recorded. Data were analysed descriptively. Differences between groups were tested with Student's t-test. Paired T-test was used when comparing data from the same implant or tooth over time. Linear model repeated measures were used to test differences between materials over time. Differences in counts were evaluated using Pearson Chi-square test. The level of significance was at p < .05. RESULTS After a mean observation time of 13.2 ± 2.4 months, 54 restorations were re-examined. The implant survival rate was 98.3%, and the restoration survival rate was 100%. One early implant failure occurred. Two minor chippings occurred in lithium-disilicate restorations. No chippings or fractures occurred in any zirconia restorations at 1 year (0%). The technical complication rate was 3.7%, with 7.7% complications among the lithium-disilicate restorations and no differences between the two materials (p = .558). At 1-year follow-up, mean Bleeding on Probing (BOP) was higher at implants (0.27 ± 0.3) than adjacent teeth (0.17 ± 0.18) (p = .046) with no differences between materials (p = .36). Differences in pocket probing depth (PPD) between implants and adjacent teeth were significant (p < .01). Jemt Index improved significantly from BL to 1-y-follow-up (p < .001). CONCLUSIONS Preliminary results were good, suggesting that the ceramic type does not impact technical and biologic parameters.
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Affiliation(s)
- Malin Strasding
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Geneva 4, Switzerland
| | - Stefan Paul Hicklin
- Clinic of Preventive Dentistry, Periodontology and Cariology, and Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ana Todorovic
- Division of Prosthodontics, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Vincent Fehmer
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Geneva 4, Switzerland
| | - Philippe Mojon
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Geneva 4, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Geneva 4, Switzerland
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Hosseini M, Worsaae N, Gotfredsen K. A five-year randomised controlled trial comparing zirconia-based versus metal-based implant-supported single-tooth restorations in the premolar region. Clin Oral Implants Res 2022; 33:792-803. [PMID: 35633183 PMCID: PMC9546362 DOI: 10.1111/clr.13960] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare 5-year biological, technical, aesthetic, and patient-reported outcomes of single-tooth implant-supported all-ceramic versus metal-ceramic restorations. MATERIALS AND METHODS Thirty patients with 63 premolar agenesis participated in the 5-year follow-up. The prosthetic treatment on single-tooth implants were randomly assigned to all-ceramic crowns on zirconia abutments (AC=31) or metal-ceramic crowns on metal abutments (MC=32). All patients were recalled to clinical examinations at baseline, 1, 3, and 5 years after prosthetic treatments. Biological, technical, and aesthetic outcomes including complications, were clinically and radiographically registered. The patient-reported outcomes were recorded using OHIP-49 questionnaire before treatment and at each follow-up examination. RESULTS At 5-year examination, the survival rate was 100% for implants and 100 % for AC and 97% for MC crowns and abutments. The marginal bone loss after 5-years was minor and not significantly different (p= 0.056) between AC (mean: 0.3, SD: 1.1) and MC restorations (mean: -0.1, SD: 0.4). The success rate of the implants based on marginal bone loss was 77.4% for AC- and 93.7% for MC-restorations. The marginal adaptation was significantly better for MC than for AC restorations (p=0.025). The aesthetic outcomes and patient-reported outcomes between AC and MC restorations were not significantly different. CONCLUSIONS The biological, aesthetic and patient-reported outcomes for implant-supported AC and MC restorations were successful and with no significant difference after 5-years. The marginal adaptation of the MC crowns cemented on titanium abutments showed significantly better fit than restorations based on zirconia crowns cemented on zirconia abutments.
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Affiliation(s)
- Mandana Hosseini
- Section of Oral Rehabilitation, Department of Odontology, Faculty of Health Science, University of Copenhagen, Denmark
| | - Nils Worsaae
- Department of Oral and Maxillofacial Surgery, University Hospital, Copenhagen, Denmark
| | - Klaus Gotfredsen
- Section of Oral Rehabilitation, Department of Odontology, Faculty of Health Science, University of Copenhagen, Denmark
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Winter KS, Greif V, Crispin A, Burgard C, Forbrig R, Liebig T, Trumm CG, Stahl R. CT-Guided Drainage of Fluid Collections Following Liver Resection: Technical and Clinical Outcome of 143 Patients during a 14-Year Period. Diagnostics (Basel) 2021; 11:826. [PMID: 34063329 DOI: 10.3390/diagnostics11050826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 01/15/2023] Open
Abstract
Purpose: To retrospectively evaluate the technical and clinical outcome of patients with symptomatic postoperative fluid collections following liver resection treated with CT-guided drainage (CTD). Methods: 143 suitable patients were examined between 2004 and 2017. Technical success was defined as (a) sufficient drainage of the fluid collection and (b) the non-occurrence of peri-interventional complications requiring surgical treatment with minor or prolonged hospitalization. Clinical success was defined as (a) decreasing or normalization of specific blood parameters within 30 days after intervention and (b) no surgical revision in addition to intervention required. C-reactive protein (CRP), leukocytes and Total Serum Bilirubin (TSB) were assessed. Dose length product (DLP) for the intervention parts was determined. Results: Technical success was achieved in 99.5% of 189 performed interventions. Clinical success was reached in 74% for CRP, in 86.7% for Leukocytes and in 62.1% for TSB. The median of successful decrease was 6.0 days for CRP, 3.5 days for Leukocytes and 5.5 days for TSB. In 90.2%, no surgical revision was necessary. Total DLP was significantly lower in the second half of the observation period (median 536.0 mGy*cm between years 2011 and 2017 vs. median 745.5 mGy*cm between years 2004 and 2010). Conclusions: Technical success rate of CTD was very high, and clinical success rate was fair to good. Reduction of the radiation dose reflects developments of CT technology and increased experience of the interventional radiologists.
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