Safety and effectiveness of radiologic and endoscopic percutaneous gastrostomy placement: A randomized study.

BACKGROUND: Gastrostomy tubes placed radiologically, endoscopically or surgically facilitate long-term home enteral nutrition (HEN). Patient-specific clinical factors may affect placement techniques, confounding direct comparisons between radiologically inserted gastrostomy (RIG) and percutaneous endoscopic gastrostomy (PEG) outcomes. This study sought to evaluate the differences in clinical outcomes in patients undergoing gastrostomy tube placement by interventional radiologists or gastroenterologists. METHODS: A single-center prospective trial randomizing patients initiating HEN to RIG or PEG was conducted between March 2018 and June 2021. Patients were followed until the time of gastrostomy removal or until 9 months after tube placement. Tracked complications included peritonitis, abscess, bleeding, bowel perforation, and tube occlusion, malposition, or damage. Periprocedural pain rating and quality of life (QoL) surveys were collected. RESULTS: Forty-two patients were randomized to RIG or PEG. Twenty patients underwent RIG (mean age, 63.0 ± 11.7 years; 85% male; 95% with head and neck cancer) and 22 patients underwent PEG (mean age, 66.3 ± 10.9 years; 81.8% male; 90.9% with head and neck cancer). RIG and PEG groups had 4.18 ± 5.49 and 2.80 ± 5.82 complications per 1000 HEN days, respectively (P = 0.357). The most frequent complications were tube malposition and abscess formation for the RIG and PEG groups, respectively. No major complications occurred in either group. There was no difference in the average of pain ratings in all pain inventory components across both groups. Both groups reported improvement in overall QoL after gastrostomy tube placement (P = 0.532). CONCLUSION: RIG is noninferior to PEG regarding complication rates, pain, and QoL when compared in a prospective randomized fashion.

A multi-institutional review of endovenous thermal ablation of the saphenous vein finds male sex and use of anticoagulation are predictors of long-term failure.

BACKGROUND: To review long-term outcomes and saphenous vein (SV) occlusion rate after endovenous ablation (EVA) for symptomatic varicose veins. METHODS: A review of our EVA database (1998-2018) with at least 3-years of clinical and sonographic follow-up. The primary end point was SV closure rate. RESULTS: 542 limbs were evaluated. 358 limbs had radiofrequency and 323 limbs had laser ablations; 542 great saphenous veins (GSV), 106 small saphenous veins (SSV) and 33 anterior accessory saphenous veins (AASV) were treated. Follow-up was 5.6 ± 2.3 years; 508 (74.6%) veins were occluded, 53 (7.8%) partially occluded and 120 (17.6%) were patent. On multivariable Cox regression analysis, male sex (HR 1.6, 95% CI [0.46-018], p = 0.012) and use anticoagulation (HR 2.0, 95% CI [0.69-0.34], p = 0.044) were predictors of long-term failure. On Kaplan-Meier curve, we had an 86.3% occlusion rate. CONCLUSION: Our experience revealed a 5-year closure rate of 86.3%. Ablations have satisfactory occlusion rate.

Safety and Effectiveness of Palliative Tunneled Peritoneal Drainage Catheters in the Management of Refractory Malignant and Non-malignant Ascites.

PURPOSE: To determine the safety and effectiveness of tunneled peritoneal catheters in the management of refractory malignant and non-malignant ascites. MATERIALS AND METHODS: An IRB-approved retrospective review was undertaken of patients who underwent ultrasound and fluoroscopy-guided tunneled peritoneal catheter placement for management of refractory malignant or non-malignant ascites between January 1, 2009, and March 14, 2014. RESULTS: A total of 137 patients (76 M/61 F, mean age 62.9 years) underwent tunneled peritoneal catheter placement for refractory malignant (N = 119; 86.9%) or non-malignant (N = 18; 13.1%) ascites. Technical success was 100% with no immediate complications. Nineteen patients (13.9%) experienced a total of 11 minor and 12 major complications. Nine patients developed a catheter-associated infection. The remaining complications included leakage at the dermatotomy site (N = 8), catheter dislodgement (N = 2), obstruction (N = 2), and groin pain (N = 2). Patients who developed a catheter-associated infection had a significantly longer catheter dwell time compared to those who did not develop an infection (median, 96.5 vs. 20 days; p < 0.01). Nine patients (6.6%) were lost to follow-up. Of the remaining 128 patients, 125 died and the majority had a catheter in place (90.4%) at the time of death. There was one catheter-associated death (bacterial peritonitis; 0.8%). The median time from catheter placement to death was significantly shorter in patients with malignant versus non-malignant ascites (18.5 vs. 85 days; p < 0.0001). CONCLUSIONS: Tunneled peritoneal drainage catheters are effective and relatively safe in the management of malignant and non-malignant ascites. Longer catheter dwell time may be a risk factor for catheter-associated infection, particularly in patients with a longer anticipated survival in the palliative setting.

Safety and effectiveness of repeat arterial closure using the AngioSeal device in patients with hepatic malignancy.

PURPOSE: To retrospectively evaluate the safety and effectiveness of the use of the AngioSeal device for repeat arterial closure in patients with hepatic malignancy. MATERIALS AND METHODS: A retrospective analysis of patients with hepatic malignancy who had undergone repeated arterial closure with the AngioSeal device was performed. All charts for patients undergoing transarterial chemoembolization or TheraSphere radioembolization were reviewed for the method of hemostasis and the number of arterial closures. A total of 53 patients (58.5% men, 41.5% women; mean age, 58.7 years) had repeat AngioSeal arterial puncture closure after chemoembolization or TheraSphere treatment. Percutaneous closure of the common femoral artery with the AngioSeal device was performed in accordance with the manufacturer's recommendations. The patients were examined for complications on follow-up. Effectiveness was defined by the ability to obtain satisfactory hemostasis. Safety was assessed by the absence of groin complications and by vessel patency on follow-up angiograms of the puncture site obtained at subsequent liver-directed therapy sessions. RESULTS: Fifty-three patients in this study group had a total of 203 common femoral artery punctures. There were a total of 161 closures with the AngioSeal device (79.3%): 58 (36%) single closures and 103 (64.0%) repeat closures. Of the 161 attempts at AngioSeal closure, there was one closure failure in the single-puncture group, yielding a success rate of 98.3%; and one closure failure in the repeat-puncture group, yielding a success rate of 99%. In these two patients, hemostasis was achieved with traditional manual compression without the need for any other device, and no complications were noted. The overall success rate of AngioSeal device closure was 98.7%. CONCLUSIONS: The repeat use of the AngioSeal closure device is safe and effective in patients with hepatic malignancy undergoing regional oncologic interventional procedures.