SIR 2024
Gastrointestinal Interventions
Ali Husnain, MD (he/him/his)
Research Specialist
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Aziz Aadam, MD
Director of Interventional Endoscopy
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Jared Green, MD
Assistant Professor of Radiology
Northwestern University Feinberg School of Medicine
Disclosure information not submitted.
Allison Reilland, n/a
Clinical Nurse
Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital
Disclosure information not submitted.
Riad Salem, MD, FSIR, MBA
Professor
Northwestern Memorial Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Ahsun Riaz, MD
Associate Professor, Interventional Radiology
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
5 procedures were performed in 4 patients. All cases were done under general anesthesia with a median fluoroscopy time and dose of 32.8 min and 2108 mGy. Transhepatic lymphangiography showed bilateral (2/4) and unilateral (2/4) retrograde hepatic lymph drainage to abnormal periduodenal lymphatic channels, confirming PLE. EGD evaluation showed methylene blue extravasation predominantly at the duodenal bulb (1/4), the anterior wall of the first portion (1/4), the anterior and posterior wall of the second portion (1/4), and proximal to the ampulla (1/4). Lymphatic embolization of the abnormal lymphatics combined with EGD RFA of the extravasation site resulted in a temporary increase in the median albumin levels after the procedure (2.6 g/dL [range: 2.2-3] vs. 3.1 g/dL [range: 2.6-3.9]). There were no significant intra and post-procedure complications.
Conclusion: Transhepatic lymphangiography and methylene blue injection with EGD evaluation of the duodenal mucosa can help diagnose PLE. Combined transhepatic lymphatic embolization and EGD RFA is helpful in treating patients with PLE.