Transarterial Embolization of Malignant Tumor-Related Gastrointestinal Bleeding: Technical and Clinical Efficacy
PAIRS Annual Meeting
intravenous dextrose infusion. The gold standard treatment is surgical excision. Success rates vary between 75% and 98%. Morbidity and mortality for open surgical excision are 35.4% and 32.8% for laparoscopic excision. Endoscopic ultrasound-guided ablation is gaining traction. However, positive localization of tumor in the pancreatic tail can be as low as 40%. Transarterial embolization is another minimally invasive option. There are seven published cases of embolization of insulinomas, with a
... uccess rate of 57%. We present two cases of successful embolization of pancreatic insulinoma. Patient 1 is an 83-yearold, multi-comorbid gentleman who presented with a loss of consciousness. A 3.2 cm lesion in the neck of the pancreas and another probable smaller lesion in the pancreatic tail were identified with arterial-phase computed tomography. His extensive comorbidity list included congestive cardiac failure and COPD as well his cognitive status precluded surgery and ablative options. His persistent hypoglycemic episodes were being managed with continuous dextrose infusion as well as octeotride infusions and corticosteroids. Embolization was performed with 0.4 mL of 250 µm polyphosphazene-coated hydrogel microspheres. All medical treatments were discontinued 48 h postprocedure with only one episode of symptomatic hypoglycemia and he was discharged. Six weeks postprocedure, the patient died due to an exacerbation of COPD. Patient 2 is a 53-year-old gentleman with increasingly frequent recurrent bouts of unresponsiveness and presented after being found unconscious. He had stage 4 chronic kidney disease and was a Jehovah's witness. A positron emission tomography avid lesion was identified in the uncinate process. The patient was intolerant of diazoxide and octreotride. He was also reluctant to use corticosteroids. He was offered surgical excision but elected to undergo embolization in view of the relative risk of intraoperative blood loss and his poor renal function. Embolization was performed with a Bern tip Direxion microcatheter. Coil protection of the pancreaticoduodenal artery with a 3.2-mm tapering microcoil was utilized to avoid nontarget embolization. Postembolization, his hypoglycemic symptoms improved with a significant reduction in his hypoglycemic episodes, which he only experience after periods of unplanned fasting. There have been no adverse outcomes following embolization, and this may prove to become a viable, safe option for those patients who are poor surgical candidates or not able to have endoscopic ultrasound-guided ablation. • Pictorial summary of diagnostic imaging strategies used in our cases • Step-wise approach to pancreatic tumor embolization including strategy to avoid nontarget embolization with the use of pancreaticoduodenal artery coil protection • Convey that transarterial embolization may provide a useful alternative for the treatment of patients with symptomatic pancreatic insulinomas. Objectives: Gastrointestinal (GI) tract bleeding is a major cause of mortality among patients with GI malignancies. We aimed to assess the technical and clinical efficacy of transarterial embolization (TAE) as a symptomatic treatment of tumorrelated GI bleeding. Methods: This study was conducted for patients with GI bleeding secondary to histopathologically proven different GI malignancies. Fourteen patients underwent TAE. Patients were followed up clinically for any complications or episodes of recurrent bleeding. Results: Fourteen patients were included (9 males and 5 females) with a mean age of 55.5 years (range 42-69 years). All procedures were technically successful with postprocedural hemorrhage control and no immediate complication. The 30-day postprocedural clinical success rate was 78.4%. Three repeated clinically successful TAE sessions were done for recurrent bleeding. The median postprocedural followup duration was 241 days. The 30-day mortality rate was 7.1%, while the overall mortality rate was 35.7%. Conclusion: TAE of tumor-related GI bleeding controlled hemorrhage with acceptable clinical success rate and without complication in this small group of patients. Objectives: Transarterial chemoembolization (TACE) is a recommended therapeutic option for many patients with hepatocellular carcinoma (HCC). Lipidol computed tomography (CT) volume measurement can predict the prognosis of unresectable HCC patients after TACE. Cone-beam CT (CBCT) technology is a useful tool for obtaining cross-sectional and three-dimensional (3D) images during TACE procedures. The aim of this study is to assess the accuracy of lipidol CBCT (Lip-CBCT) versus conventional CT volume measurements for HCC after TACE. Methods: Conventional TACE was used to treat 10 patients with HCC. Lip-CBCT was performed to assess lipiodol deposition directly after TACE. Unenhanced multidetector CT scan was performed 1 h after TACE. Volumetric measurement of lipidol uptake by the tumor was performed in both CBCT and conventional CT by semiautomatic 3D volume segmentation and compared using linear regression to evaluate consistency between the two imaging modalities. Results: The relationship between CT volumetric and Lip-CBCT volumetric was found to be statistically significant with Spearman's correlation coefficient (r = 0.706). According to the Wilcoxon signed-rank test, the median ranged from post-CBCT volumetric is 40.19 and from CT volumetric is 39.1. There was a significant correlation between plain CT value and CBCT value, with a Pearson's correlation coefficient of 0.31 (P < 0.001). Conclusion: Lip-CBCT can accurately assess the tumor volume after TACE with results statistically symmetrical to conventional CT results.