Interventional radiology in liver and pancreatic diseases

Interventional Radiology in Liver and Pancreatic Diseases

Transarterial Chemo embolization

Transarterial Chemo embolization (TACE) is a minimally invasive treatment performed by an interventional radiologist for treating liver tumors such as hepatocellular carcinoma, neuroendocrine tumors or cholangiocarcinoma. The doctor makes a tiny cut in the skin and inserts a catheter (a thin, flexible tube) into the femoral artery (the large artery of the leg). The catheter is then manoeuvred into place, guided by live X-rays. Using image guidance, a chemotherapy agent is delivered into the tumor and a blood vessel blocking agent (embolic) is introduced through the blood vessel supplying the tumor to stop its blood supply and to deliver chemotherapy in the same setting.

Disease / Conditions treated: Liver cancers (Hepatocellular carcinoma, neuroendocrine tumors or cholangiocarcinoma, Colo-rectal liver metastasis)

Type of stay: Inpatient


Expected duration of stay: 2 days.


Benefits:

  • Controls tumour progression and reduces tumour load significantly. In large tumours, repeat procedure may be required to achieve maximum tumour treatment.
  • Proven treatment option for unresectable liver tumours.
  • Short hospital stay

Side effects:Post-embolisation syndrome (Tiredness, Nausea, in some cases vomiting)


Transarterial Radioembolization

Transarterial Radioembolization (TARE), or selective internal radiation therapy (SIRT), is a treatment used to destroy liver tumors. The doctor makes a tiny cut in the skin and inserts a catheter (a thin, flexible tube) into the femoral artery (the large artery of the leg). The catheter is then manoeuvred into place, guided by live X-rays. Once at the tumor site, the doctor injects the radioactive beads into the blood vessels that supply the tumor. The beads give off radiation over a very short distance, which concentrates the radiation inside the tumor, helping to reduce radiation exposure to the rest of the body. This treatment may also be referred to as Y-90 because it commonly uses a radioactive isotope called Yttrium 90.

Disease / Conditions treated: Liver cancers (Hepatocellular carcinoma, Colorectal liver metastasis)


Type of stay: Inpatient


Expected duration of stay:1 day for lung shunt assessment and 2 days for TARE.


Benefits:

  • Causes destruction of tumour cells exposed to the radiation isotope.
  • Proven treatment option for unresectable liver tumours.
  • Short hospital stay

Side effects:Post-embolisation syndrome (Tiredness, Nausea, in some cases vomiting)

Duodenal ulcers may occur in a few patients.

Microwave ablation of liver tumor

Microwave ablation (MWA) uses electromagnetic waves to destroy a tumor. The tumor is localized via image guidance, and a thin microwave antenna is placed directly into the tumor. A microwave generator emits an electromagnetic wave through the antenna, and these waves agitate water molecules in the surrounding tissue. The friction and heat generated by this action cause cell death helping to destroy the tumor.

Disease / Conditions treated:Liver cancers (Hepatocellular carcinoma, Colorectal liver metastasis)


Type of stay: Inpatient


Expected duration of stay:2 days.


Benefits:

  • Causes thermal ablation of the tumour and a very small volume of surrounding normal liver.
  • Curative treatment option in small liver tumours less than 3 cms and less than three in number.
  • Short hospital stay

Side effects:Mild discomfort for a day or two in the upper abdomen.

Radiofrequency ablation

Radiofrequency ablation (RFA) uses radio waves to create heat and damage tissue. RFA is used to decrease pain by damaging pain-sensing nerves or to treat cancer by damaging tumor cells. A probe is placed into the target tissue where they emit an electrical current to transmit radio waves to the surrounding tissue, which heats up, causing cells to die.

Disease / Conditions treated:Liver cancers (Hepatocellular carcinoma, Colorectal liver metastasis)


Type of stay: Inpatient


Expected duration of stay:2 days.


Benefits:

  • Causes thermal ablation of the tumour and a very small volume of surrounding normal liver.
  • Curative treatment option in small liver tumours less than 3 cms and less than three in number when surgery is not possible.
  • Short hospital stay

Side effects:Mild discomfort for a day or two in the upper abdomen.

Transjugular intrahepatic portosystemic shunt

Transjugular intrahepatic portosystemic shunt (TIPS) is a technique used to reduce internal bleeding in the stomach and esophagus in cirrhosis patients by creating a shunt to bypass the liver. A stent (a tiny mesh tube) is placed to keep the connection open and allow it to bring blood draining from the bowel back to the heart while avoiding the liver.

Disease / Conditions treated:Portal hypertension in cirrhotic patients, Patients with variceal bleeding.


Type of stay: Inpatient


Expected duration of stay:3 days.


Benefits:

  • Reduces portal hypertension and in turn variceal bleeding.
  • Reduces ascitis formation in patients with refractory portal hypertension.
  • Bridge to surgery in patients waiting for liver transplant

Side effects:Hepatic encephalopathy (uncommon)


Portal vein Embolisation

Portal vein Embolisation(PVE) is a special procedure used to grow the patients liver before surgery is performed. This is considered when the amount of liver that can be left behind for the patient after liver resection for tumor removal is judged to be too small. Here the radiologist blocks the blood supply to the part of the liver, which is planned for removal. This leads to increased blood supply to the healthy part of liver leading to its growth in 4-6 weeks. Surgery can be performed safely after that.

Disease / Conditions treated:Patients with resectable HCC, Cholangiocarcinomas, Hemangiomas


Type of stay: Inpatient


Expected duration of stay:3 days.


Benefits:

  • Reduces risk of liver decompensation after surgery

Side effects:Mild discomfort for a day or two in the upper abdomen.


Percutaneous transhepatic biliary drainage

Percutaneous transhepatic biliary drainage is a minimally invasive procedure, through the skin, to drain the bile juice, when its flow gets blocked due to stones in its path or by malignant or non-malignant causes. The procedure involves introducing a pen refill sized small tube into the body under ultrasound and Fluoroscopic guidance.

Disease / Conditions treated:Klatskin tumour, Cholangiocarcinomas, Carcinoma head of pancreas causing bile stasis.


Type of stay: Inpatient


Expected duration of stay:3 days.


Benefits:

  • Reduces bilirubin level (jaundice).
  • Reduces risk of liver decompensation.
  • More useful in patients in septic shock due to cholangitis.

Side effects:Mild discomfort for a day or two in the upper abdomen.

Hepatic Venous Portal Gradient (HVPG)

Hepatic Venous Portal Gradient (HVPG) is a short, minimally invasive procedure, that helps an Interventional Radiologist assess the exact pressure gradient between the inflow and outflow blood in the liver (portal vein and hepatic vein respectively). The pressure gradient is useful in decision making in prospective transplant candidates and people having variceal bleeding.

Disease / Conditions treated:Pateints with resectable HCC, Cholangiocarcinomas, Hemangiomas to assess portal pressures


Type of stay: Daycare


Expected duration of stay:1 day.


Benefits:

  • Aids decision making for surgery / TIPS

Side effects:Nil


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