Asia/Pacific

Hyun-ki Yoon, MD

Luke Toh, MBBS, FRCR, FAMS

Justin Guan, MD

This issue of Digestive Disease Interventions (DDI) will address multiple areas of gastrointestinal disease interventions, including hepatocellular cancer (HCC) management practices in Korea and China, plug-assisted retrograde transvenous obliteration (PARTO) for the management of gastric varices (GV) with associated gastrorenal shunt, hepatobiliary interventions including percutaneous biliary endoscopy (PBE) and percutaneous placement of plastic biliary stents, lymphangiography for postsurgical leaks, pediatric gastrointestinal interventions, interventional radiology (IR) training in Singapore, and developing an IR service line in Vietnam.

Guest editors for this issue include Dr. Justin Guan, an Associate Staff Physician in Interventional Radiology at Cleveland Clinic and Assistant Professor of Radiology at the Lerner College of Medicine of Case Western Reserve University. His interests include embolization, interventional oncology, and cholangioscopy. Next, Dr. Hyun-ki Yoon, a Professor of Radiology at the University of Ulsan College of Medicine and Interventional Radiologist working in Asan Medical Center, Seoul, Republic of Korea, is former department chairman and currently the president of Society of Gastrointestinal Intervention (SGI). He has published many articles on hepatobiliary, gastrointestinal, and vascular interventions. Finally, Dr. Luke Toh, Senior Consultant and Head of the Department of Diagnostic and Interventional Imaging at KK Women's and Children's Hospital, is Senior Consultant at the Department of Vascular and Interventional Radiology at Singapore General Hospital; he is also a Clinical Assistant Professor at Duke-NUS School of Medicine, and Adjunct Assistant Professor of the Department of Anatomy at Yong Loo Lin School of Medicine, National University of Singapore. Dr. Toh is fellowship trained in pediatric interventional radiology; he also has special interests in vascular anomalies, women's and urological interventions.

Management of HCC has recently been updated in many countries in the Asia-Pacific; yet, depending on the region, significant differences exist in the pathogenesis for HCC and its treatment strategies. Etiology of HCC is more often hepatitis B or C in Asia, while other etiologies such as alcoholic and metabolic-associated liver disease are more common in the United States. Among the treatment options for HCC, conventional transarterial chemoembolization (TACE) using lipiodol has been the mainstay strategy in Asia, while TACE with drug-eluting beads (DEB-TACE) and transarterial radioembolization are more widely used in the United States. Ablation treatments such as radiofrequency ablation have been used similarly in both regions. Nowadays, more similar approaches to HCC are observed due to both widespread use of guidelines, such as the BCLC guideline, and increased communications between the regions via international conferences.

GV with portosystemic shunt is another clinical problem most interventional radiologists encounter in the management of portal hypertensive patients. Conventional balloon-occluded retrograde transvenous obliteration (BRTO) has successfully treated many GV cases, but performing BRTO correctly is often technically challenging. More recently, PARTO, a modified form of BRTO, has become widely accepted in many Korean medical centers as an alternative to conventional BRTO.

In terms of biliary disease, management of choledocholithiasis and biliary strictures via PBE has seen significant developments in both Asia and the United States. Although PBE has been available in East Asian countries like Japan and South Korea since the 1970s, PBE has only recently seen a resurgence in the United States due to improvements of endoscope technology, particularly with the availability of new disposable endoscopes. Etiologies for biliary strictures and stone formation differ between the two regions, with the prevalence of recurrent pyogenic cholangitis (also known as oriental cholangiohepatitis) in Asia being a major driver of biliary strictures and stone formation, while postoperative and autoimmune etiologies like primary sclerosing cholangitis are more common drivers for biliary strictures in the United States.

This issue will address multiple areas of gastrointestinal disease interventions. First, it presents current HCC treatment guidelines in East Asia, specifically in South Korea and China. Cho et al will introduce updated Korean HCC management guidelines and offer a glimpse of the real-world clinical situations in many Korean medical centers. Zhang et al will also review the current HCC evaluation and management algorithms in China.

Focus will then shift toward portal hypertension interventions, particularly PARTO for GV associated with gastrorenal shunt, followed by hepatobiliary pathologies, then management options for postsurgical lymphatic leaks. Gwon, who is the main modifier of PARTO from South Korea, will comprehensively review the technical aspects and clinical outcomes of PARTO, which will give valuable information to IR doctors who manage GV patients. Naganatanahalli et al from the United States will review PBE, including patient evaluation, techniques, and outcomes. Santoso et al from Indonesia will present a retrospective review of percutaneous placement of plastic biliary stents in patients who have failed endoscopic retrograde cholangiopancreatography, and Sato et al from Japan will review techniques for diagnostic and therapeutic lymphangiography in patients with postsurgical lymphatic leaks.

Finally, this issue will close with a review of pediatric gastrointestinal interventions provided by Dr. Chennapragada, pediatric interventional radiologist from Australia, and two special articles regarding IR training in Singapore by Chua et al and developing an IR service line in Vietnam by Dr. Lane Nguyen. The editors and authors involved in this special Asia-Pacific Issue of DDI sincerely hope you enjoy reading these topics as much as we have enjoyed putting it together.

Publication History

Article published online:
26 August 2024