Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(05): E622-E633
DOI: 10.1055/a-1797-8681
Original article

Fusion radiology in interventional endoscopy (FRIend): a new approach for pancreatic fluid collections

Romano Sassatelli
1   Azienda USL, IRCCs di Reggio Emilia, Epidemiology Unit, Reggio Emilia, Emilia-Romagna, Italy
,
Simone Grillo
1   Azienda USL, IRCCs di Reggio Emilia, Epidemiology Unit, Reggio Emilia, Emilia-Romagna, Italy
,
Marta Ottone
2   Azienda USL, IRCCs di Reggio Emilia, Gastroenterology and Digestive Endoscopy Unit, Reggio Emilia, Emilia-Romagna, Italy
,
Giulia Besutti
3   Azienda USL, IRCCs di Reggio Emilia, Radiology Unit Reggio Emilia, Emilia-Romagna, Italy
,
Paolo Cecinato
1   Azienda USL, IRCCs di Reggio Emilia, Epidemiology Unit, Reggio Emilia, Emilia-Romagna, Italy
,
Giuliana Sereni
1   Azienda USL, IRCCs di Reggio Emilia, Epidemiology Unit, Reggio Emilia, Emilia-Romagna, Italy
,
Vincenzo Giorgio Mirante
1   Azienda USL, IRCCs di Reggio Emilia, Epidemiology Unit, Reggio Emilia, Emilia-Romagna, Italy
,
Veronica Iori
1   Azienda USL, IRCCs di Reggio Emilia, Epidemiology Unit, Reggio Emilia, Emilia-Romagna, Italy
,
Pierpaolo Pattacini
3   Azienda USL, IRCCs di Reggio Emilia, Radiology Unit Reggio Emilia, Emilia-Romagna, Italy
,
Paolo Giorgi Rossi
2   Azienda USL, IRCCs di Reggio Emilia, Gastroenterology and Digestive Endoscopy Unit, Reggio Emilia, Emilia-Romagna, Italy
› Author AffiliationsTRIAL REGISTRATION: Single-Center, observational, retrospective study at clinicaltrials.gov
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Fusion imaging consists of overlaying preoperative imaging over live fluoroscopy, providing an augmented live guidance. Since 2017, we have been using a new hybrid operating room (Discovery IGS 740 OR, GE Healthcare) for biliopancreatic endoscopy, combining fusion imaging with traditional endoscopic ultrasound (EUS). This study aimed to assess the advantages that fusion imaging could bring to EUS-guided drainage of post-pancreatitis fluid collections.

Patients and methods Thirty-five drainage procedures performed between 2012 and 2019 with traditional guidance and fusion imaging were retrospectively compared, assessing the overall treatment success rate – i. e. symptom improvement with complete PFC emptying – as a primary outcome.

Secondary outcomes included technical success rate, time to resolution, hospital stay length, adverse events, recurrence rate, and procedure time.

Results Patients treated with standard EUS (n = 17) and with fusion imaging (n = 18) were homogeneous in age, gender, pancreatitis etiology, and indication for drainage; the second group had larger PFCs, more frequently walled-off necrosis than pseudocysts, and were treated more emergently, indicating higher case complexity in this group. During the period when fusion imaging was adopted, procedures had a higher overall treatment success rate than during the period when standard EUS was adopted (83.3 % vs. 52.9 %, P = 0.075), and complete emptying was reached in less time (61.1 % vs. 23.6 % complete emptying within 90 days, P = 0.154), differences compatible with random fluctuations.

Conclusions This study suggests that fusion imaging in combination with EUS might improve clinical and procedural outcomes of PFC drainage.

Supplementary material



Publication History

Received: 09 August 2021

Accepted after revision: 07 March 2022

Article published online:
13 May 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Roberts SE, Morrison-Rees S, John A. et al. The incidence and aetiology of acute pancreatitis across Europe. Pancreatology 2017; 17: 155-165
    CrossrefPubMedSearch in Google Scholar
  • 2 Gapp J, Hall AG, Walters RW. et al. Trends and outcomes of hospitalizations related to acute pancreatitis: Epidemiology from 2001 to 2014 in the United States. Pancreas 2019; 48: 548-554
    CrossrefPubMedSearch in Google Scholar
  • 3 Surgical Treatment: Evidence-Based and Problem-Oriented. Holzheimer RG, Mannick JA. Munich: Zuckschwerdt; 2001
    Search in Google Scholar
  • 4 Trikudanathan G, Wolbrink DRJ, van Santvoort HC. et al. Current concepts in severe acute and necrotizing pancreatitis: an evidence-based approach. Gastroenterology 2019; 156: 1994-2007.e3
    CrossrefPubMedSearch in Google Scholar
  • 5 Janisch NH, Gardner TB. Advances in management of acute pancreatitis. Gastroenterol Clin N Am 2016; 45: 1-8
    CrossrefPubMedSearch in Google Scholar
  • 6 Banks PA, Bollen TL, Dervenis C. et al. Classification of acute pancreatitis - 2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111
    CrossrefPubMedSearch in Google Scholar
  • 7 Arvanitakis M, Dumonceau JM, Albert J. et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy 2018; 50: 524-546
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Crockett SD, Wani S, Gardner TB. et al. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. Gastroenterology 2018; 154: 1096-1101
    CrossrefPubMedSearch in Google Scholar
  • 9 van Brunschot S, van Grinsven J, van Santvoort HC. et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet 2018; 391: 51-58
    CrossrefPubMedSearch in Google Scholar
  • 10 Renelus BD, Jamorabo DS, Gurm HK. et al. Comparative outcomes of endoscopic ultrasound-guided cystogastrostomy for peripancreatic fluid collections: a systematic review and meta-analysis. Ther Adv Gastrointest Endosc 2019; 14: 12-26
    PubMedSearch in Google Scholar
  • 11 Appelbaum L, Mahgerefteh SY, Sosna J. et al. Image-guided fusion and navigation: applications in tumor ablation. Tech Vasc Interv Radiol 2013; 16: 287-295
    CrossrefPubMedSearch in Google Scholar
  • 12 Hertault A, Maurel B, Sobocinski J. et al. Impact of hybrid rooms with image fusion on radiation exposure during endovascular aortic repair. Eur J Vasc Endovasc Surg 2014; 48: 382-390
    CrossrefPubMedSearch in Google Scholar
  • 13 Tenorio ER, Oderich GS, Sandri GA. et al. Impact of onlay fusion and cone beam computed tomography on radiation exposure and technical assessment of fenestrated-branched endovascular aortic repair. J Vasc Surg 2019; 69: 1045-1058.e3
    CrossrefPubMedSearch in Google Scholar
  • 14 Di Mauro E, Solbiati M, De Beni S. et al. Virtual navigator real-time ultrasound fusion imaging with positron emission tomography for liver interventions. Conf Proc IEEE Eng Med Biol Soc 2013; 2013: 1406-1409
    PubMedSearch in Google Scholar
  • 15 Rajagopal M, Venkatesan AM. Image fusion and navigation platforms for percutaneous image-guided interventions. Abdom Radiol 2016; 41: 620-628
    CrossrefPubMedSearch in Google Scholar
  • 16 Cornelis FH, Borgheresi A, Petre EN. et al. Hepatic arterial embolization using cone beam ct with tumor feeding vessel detection software: impact on hepatocellular carcinoma response. Cardiovasc Intervent Radiol 2018; 41: 104-111
    CrossrefPubMedSearch in Google Scholar
  • 17 Iwazawa J, Ohue S, Hashimoto N. et al. Comparison of the number of image acquisitions and procedural time required for transarterial chemoembolization of hepatocellular carcinoma with and without tumor-feeder detection software. Radiol Res Pract 2013; 2013: 580839
    PubMedSearch in Google Scholar
  • 18 Cheng I, Shen R, Moreau R. et al. An augmented reality framework for optimization of computer assisted navigation in endovascular surgery. Conf Proc IEEE End Med Biol Soc 2014; 2014: 5647-5650
    PubMedSearch in Google Scholar
  • 19 Zhang H, Chen GY, Xiao L. et al. Fusion guidance facilitating percutaneous catheter drainage in treatment of acute pancreatitis complicated with infected walled-off necrosis. Pancreatology 2018; 18: 635-641
    CrossrefPubMedSearch in Google Scholar
  • 20 Ewertsen C, Saftoiu A, Gruionu LG. et al. Real-time image fusion involving diagnostic ultrasound. AJR Am J Roentgenol 2013; 200: W249-W255
    CrossrefPubMedSearch in Google Scholar
  • 21 Obstein LO, Estépar RS, Jayender J. et al. Image Registrated Gastroscopic Ultrasound (IRGUS) in human subject: a pilot study to assess feasibility. Endoscopy 2011; 43: 394-399
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Kuszyk BS, Heath DG, Bliss DF. et al. Skeletal 3-D CT: advantages of volume rendering over surface rendering. Skeletal Radiol 1996; 25: 207-214
    CrossrefPubMedSearch in Google Scholar
  • 23 Early DS, Acosta RD. ASGE Standards of Practice Committee. et al. Adverse events associated with EUS and EUS with FNA. Gastrointest Endosc 2013; 77: 839-843
    CrossrefPubMedSearch in Google Scholar
  • 24 Arvanitakis M, Dumonceau JM, Albert J. et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy 2018; 50: 524-546
    Thieme ConnectPubMedSearch in Google Scholar