Complementary roles of interventional radiology and therapeutic endoscopy in gastroenterology

Abstract

Acute upper and lower gastrointestinal bleeding, enteral feeding, cecostomy tubes and luminal strictures are some of the common reasons for gastroenterology service. While surgery was initially considered the main treatment modality, the advent of both therapeutic endoscopy and interventional radiology have resulted in the paradigm shift in the management of these conditions. In this paper, we discuss the patient’s work up, indications, and complementary roles of endoscopic and angiographic management in the settings of gastrointestinal bleeding, enteral feeding, cecostomy tube placement and luminal strictures. These conditions often require multidisciplinary approaches involving a team of interventional radiologists, gastroenterologists and surgeons. Further, the authors also aim to describe how the fields of interventional radiology and gastrointestinal endoscopy are overlapping and complementary in the management of these complex conditions.

Endovascular hemostasis for endoscopic procedure-related gastrointestinal bleeding

“…Indications for gastrostomy tube use are for nutrition support in patients with an impaired swallowing mechanism associated with neurological and neoplastic conditions. 46,47 Gastrostomy tube insertion is performed surgically or percutaneous under endo- scopic or fluoroscopic guidance. PEG is one of the most common endoscopic procedure worldwide.…”

Interventional radiology-operated endoscopy using the LithoVue disposable endoscope: Approach, technical success, clinical outcomes, and complications

“…Given the increasing number of patients with postsurgical anatomy of the proximal bowel (e.g., Roux-en-Y gastric bypass), interventional radiology-operated choledochoscopy has made a resurgence. [ 1 ] Urologists routinely perform endoscopy-guided percutaneous nephrolithotomy,[ 2 3 ] and gastrointestinal endoscopy[ 4 5 ] has become a mainstay of gastroenterology practice. The endoscopic techniques used by interventional radiologists, in general, rarely differ from those of urologists or gastroenterologists.…”

Percutaneous Biliary Endoscopy

“…More recently, however, a resurgence of interest has been ignited in the interventional radiology community. [2][3][4][5][6] Interventional radiologists are uniquely equipped to integrate endoscopy into many of their commonly performed image-guided procedures, particularly in biliary, gastrointestinal, and genitourinary interventions. This can be attributed to the high degree of manual dexterity that is often required to execute interventional procedures.…”