Complications of Image Guided Liver Interventions

1. Complications of Image Guided Liver Interventions

2. Personal Profile: • I am a medical doctor from Kurdistan/ Iraq. • I graduated in June 2006, and upon completion of my internship, I started studying at Curtin University. • I am interested in this area because: • Importance of the procedure in diagnosing various liver diseases, as mentioned. • Lack of availability of the technique in Kurdistan.

3. Background Liver, as an essential organ in the body, may be included in many disease processes, which may originate in the liver itself or outside this “large” organ. Some of them are simple asymptomatic, while in others early accurate diagnosis and management will be necessary. Accurate diagnosis of a liver lesion will depend, to a large extent, on the pre-operative histological or cytological assessment of that lesion. in spite of the huge progress of non-invasive imaging techniques, histological or cytological diagnosis are crucial.

4. Introduction: • Liver diseases can be focal or diffuse. • Focal liver lesion is defined as a localized area of abnormality within the liver substance, e.g. primary or secondary tumours, localized pus (abscess), or other areas of localized inflammation. • Diffuse: mean involving large areas of liver substance like chronic hepatitis (B or C) and cirrhosis.

5. Cont. • There are no relevant statistical data regarding incidence and prevalence of liver diseases in Kurdistan/ Iraq. • In developing countries, there are many inflammatory and infective focal liver lesions like abscess (bacterial and amoebic) & cysts (like Hydatid). • The Liver is an important site for primary tumours both benign and malignant. • Malignant tumour (hepatoma) are raising especially in areas with high prevalence of chronic hepatitis (hepatitis B & C). • Very common site for secondary tumours from other regions like carcinoma of Colon.

6. Image guided percutaneous liver biopsy (IGPLB) • Image guided percutaneous liver biopsy (IGPLB) defined as inserting needle(s) into liver through the overlying skin under radiological control (e.g. ultrasound or CT). • IGPLB is the most widely used interventional radiological techniques nowadays. • Less morbidity, lower costs, and shorter hospital stay are most recognized advantages.

7. 63-year-old woman with focal liver lesions in (Sarcoidosis) Jung, G. et al. Am. J. Roentgenol. 2004;183:171-173

8. Aim of the Study • To study complications of IGPLB. • To examine rates of different complications. • To comparing different complications using different needle size. Some procedures need large size needles e.g. 13 or 14, while others could be performed with smaller size needles like 21 or 23. • To estimate costs spent in dealing with these complications, with regards to medications, investigations, hospital admission and possible re-interventions.

9. Complications: • Minor Complications: Mainly PAIN at the biopsy site or right shoulder, requiring simple analgesics. • Major Complications: Require admission to hospital to deal with this complication, which could be bleeding, peritonitis, injury to intestine, ..etc.

10. Data Collection: • It is hoped that the study will be undertaken in Perth with collaboration from the Liver Research Unit at Royal Perth Hospital. • I will attend (if possible and after permission) all the procedures in the hospital.

11. Study Design • Medical case sheets of approximately (50) patients will be the most important source for data collections. Regarding: age, gender, complains of the patients, indications for biopsy, laboratory and diagnostic imaging results, in addition the histopathological results of the specimen. • Direct questionnaires to the patients, both before and after the procedure. Regarding: Ethnic background, Past history of the complaint, Family history, and their experience following the procedure.

12. Data Analysis • Using SPSS 15. • Graphs, tables and charts will be tabulated. • Analysing information of the medical case sheets and direct questionnaires for: • Age, gender, ethnic group. • Indications for performing these procedures. • Complication rates. • Methods in dealing with these complications, especially costs.

13. Ethical Issues • Study is submitted to Curtin University, relevant hospitals, and any other ethics committee, for approval, before commencement. • Anonymity and confidentiality of the patients will be protected. • Written information to the participants regarding the aim of the study. • Acknowledgment of all sources, doctors and authors who going to help in accomplishing the proposed study.

14. Contd. Courtesy: Koenraad J. Mortelé, MD and Pablo R. Ros, MD

15. References: • Interventional Radiology Treatments for Liver Cancer. [cited May 13, 2008]. • Thulkar s. Image Guided Biopsy Procedures. Indian Journal of medical and paediatric oncology. 2007 [cited May 13, 2008]; 28(2). • Pasha T, Gabriel S, Therneau T, Dickson ER, Lindor KD. Cost effectiveness of ultrasound guided liver biopsy. Hepatology. 1998 [cited May 13, 2008]; 27:1220-1226. • Haslett, C., E. Chilvrs, et al. (2002). DAVIDSON'S Principles and Practice of MEDICINE

16. Thank You