Phase I/II Study of Transjugular Transhepatic Peritoneovenous Venous Shunt, a New Procedure to Manage Refractory Ascites in Cancer Patients: Japan Interventional Radiology in Oncology Study Group 0201

Inaba, Yoshitaka; Sone, Miyuki; Saitoh, Hiroya; Takeuchi, Yoshito; Shioyama, Yasukazu; Nakajima, Yasuo

doi:10.2214/ajr.10.4716

Cited by 5 publications

(3 citation statements)

References 15 publications

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“…These drainage techniques include internal drainage like peritoneo-venous 5 , peritoneo-gastric 6 and peritoneo-cystic 7 shunting and external drainage techniques requiring the placement of an indwelling, tunneled peritoneal drainage or portcatheter. 2 , 3 , 5 , 8 – 13 An important disadvantage of external drainage is albumin loss, which may need to be considered in deciding between external drainage and internal shunts. Most of the experience with indwelling drainage catheters has been described with the PleurX catheter; this monocuffed catheter was initially designed for drainage of malignant pleural effusions but it can also be used for drainage of malignant peritoneal fluid.…”

Section: Introductionmentioning

confidence: 99%

Tenckhoff tunneled peritoneal catheter placement in the palliative treatment of malignant ascites: technical results and overall clinical outcome

Maleux

Indesteege

Laenen

et al. 2016

Radiology and Oncology

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BackgroundTo assess the technical and clinical outcome of percutaneous insertion of tunneled peritoneal catheters in the palliative treatment of refractory malignant ascites and to determine the safety and feasibility of intraperitoneal administration of cytotoxic drugs through the tunneled catheter.Materials and methodsConsecutive patients palliatively treated with a tunneled peritoneal catheter to drain the malignant ascites were identified. Patients’ medical history, procedural and clinical follow-up data, including complications and estimated survival, were reviewed. Additionally, a sub analysis of the patients with widespread ovarian cancer and refractory ascites treated with or without intraperitoneal administration of cytotoxic drugs was made.ResultsIn all 94 patients it was technically feasible to insert the peritoneal drainage catheter and to drain a median of 3260 cc (range 100 cc – 8500 cc) of malignant ascitic fluid. Post procedural complications included catheter infection (n = 2; 2%), fluid leakage around the entry site (n = 4; 4%), catheter occlusion (n = 2; 2%), sleeve formation around the catheter tip (n = 1; 1%) and accidental loss of the catheter (n = 1; 1%). There was no increase in catheter infection rate in patients treated with or without intraperitoneal administration of cytotoxic drugs. Median overall survival after catheter insertion is 1.7 months.ConclusionsPercutaneous insertion of a tunneled Tenckhoff catheter for the palliative drainage of malignant ascites and intraperitoneal infusion of cytotoxic drugs is feasible and associated with a very low complication rate, including catheter infection. These tunneled peritoneal lines are beneficial for symptomatic palliative treatment of refractory ascites and allow safe intraperitoneal chemotherapy.

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Section: Introductionmentioning

confidence: 99%

Tenckhoff tunneled peritoneal catheter placement in the palliative treatment of malignant ascites: technical results and overall clinical outcome

Maleux

Indesteege

Laenen

et al. 2016

Radiology and Oncology

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“…To ensure amenability to paracentesis, the procedure is usually delayed until the ascites is tense, further worsening the symptoms and quality of life of the patient. Alternative, more invasive, drainage options to avoid repeated paracentesis are indwelling catheters for external drainage [5] or internal drainage, such as peritoneo-gastric [6], peritoneo-cystic [7], peritoneo-venous [8], and transjugular intrahepatic portosystemic shunts (TIPS) [9]. All of these procedures may require frequent visits to the hospital for severely ill patients and specialized care of the devices.…”

Section: Casementioning

confidence: 99%

Endoscopic ultrasound-guided placement of plastic pigtail stents for the drainage of refractory malignant ascites

et al. 2017

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Endoscopic ultrasound (EUS)-guided drainage is now the treatment of choice in cases of pancreatic pseudocysts and walled-off necrosis, especially in the absence of luminal bulging and in patients with portal hypertension. Malignant refractory ascites usually heralds a poor prognosis and substantially impairs the quality of life of patients because of the symptoms experienced and the need for repeated paracentesis. EUS-guided placement of lumen-apposing, fully covered, self-expandable metal stents (FCSEMS) has been reported for the drainage of malignant ascites. Herein, we present the results of EUS-guided placement of plastic pigtails stents for the drainage of refractory malignant ascites in three patients. The aim was to improve symptoms and minimize the possible drawbacks of large-caliber FCSEMS. In this preliminary experience, EUS-guided placement of plastic stents was feasible and avoided further paracentesis.

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“…Arai et al (82) have recently described the use of a novel transjugular transhepatic peritoneovenous shunt in patients with malignant ascites, with access into the abdominal cavity via a TIPS needle. This technique avoids the long subcutaneous tunneling required for Denver shunt placement and may be less invasive and more advantageous if catheter exchange is needed (82).…”

Section: Peritoneovenous Shuntmentioning

confidence: 99%

Image-guided Intervention in Management of Complications of Portal Hypertension: More than TIPS for Success

Kirby¹,

Cho²,

Midia³

2013

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Management of clinically important sequelae of portal hypertension, such as variceal bleeding and ascites, may involve a combination of medical, endoscopic, surgical, and interventional approaches and procedures. Although clinically significant esophageal and rectal varices are typically visible endoscopically, ectopic varices may require multiplanar portal venous phase computed tomography or magnetic resonance imaging for diagnosis. A detailed understanding of individual vascular anatomy, flow dynamics, and patient-related factors such as cardiac and hepatic status is necessary for appropriate treatment selection in patients with complicated portal hypertension. The hepatic venous pressure gradient is the key indirect measurement of portal venous pressure. Transjugular intrahepatic portosystemic shunt (TIPS) placement is regarded as the archetypal intervention for treating complicated portal hypertension by reducing portal pressure. Various modifications, such as direct portocaval shunt, may be used in patients with challenging vascular anatomy. A subset of patients with obstructed hepatic venous outflow or portal venous inflow should be considered for recanalization. Splenic artery embolization may be considered for reduction of portal pressure in selected patients, particularly when hypersplenism or splenic vein occlusion is a prominent feature. Gastric and ectopic varices may bleed even when the portal pressure is low, and balloon-occluded retrograde transvenous obliteration (BRTO) in such patients may lead to equal or improved outcome compared with TIPS placement. BRTO is not limited by poor hepatic reserve or encephalopathy; however, it does not reduce portal pressure and may aggravate esophageal varices. Interventional radiology plays an important role in maintaining the patency of surgically created portosystemic shunts, and it remains at the forefront of new approaches in shunt design and placement. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.335125166/-/DC1.

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Phase I/II Study of Transjugular Transhepatic Peritoneovenous Venous Shunt, a New Procedure to Manage Refractory Ascites in Cancer Patients: Japan Interventional Radiology in Oncology Study Group 0201

Abstract: Transjugular transhepatic PVS is a safe and feasible procedure for managing refractory ascites in patients with cancer. Sufficient efficacy was observed in our initial experience, but a larger clinical trial is warranted.

Cited by 5 publications

References 15 publications

Tenckhoff tunneled peritoneal catheter placement in the palliative treatment of malignant ascites: technical results and overall clinical outcome

Tenckhoff tunneled peritoneal catheter placement in the palliative treatment of malignant ascites: technical results and overall clinical outcome

Endoscopic ultrasound-guided placement of plastic pigtail stents for the drainage of refractory malignant ascites

Image-guided Intervention in Management of Complications of Portal Hypertension: More than TIPS for Success

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