Marra P.: The nick of time - an IR approach to managing upper GI bleeding (ID2115)
The ESPGHAN podcast guest today is Dr Paolo Marra – the interviewer, as our producer, Selma Ertl already has told you, is same old same old me – to round out the team, a hat-tip to Manuel Schuster, engineer. Let’s get starty with the party!
So, Dr Marra – an interventional radiologist, and like everyone across from whom I sit in these sessions, amazingly young to have accomplished so much. He is an expert in how to deal with a not infrequent complication of premature birth – thrombosis of the external portal vein, a sequela of caregivers’ need for vascular access, via the umbilical vein, across the vena porta through the ductus venosus Arantii and into the vena cava. With thrombosis comes portal hypertension, of course. How to address portal hypertension of this aetiology – shunting, yes, but at what sites and how? – has for years been a concern of the liver team at Bergamo, Italy, where Dr Marra now works. He believes that interventional-radiology approaches, rather than surgical ones, may be well-suited to certain patients.
The Bergamo team argue for portal-vein recanalisation rather than transjugular intrahepatic portosystemic shunt (TIPS) placement, adducing these considerations: TIPS is poorly suited to the small and to the young, with substantial potential for injury during the procedure. A portosystemic shunt has its own adverse outcomes (nodular regenerative hyperplasia, even malignancy) -- why open a new shunt when we prefer to close them? TIPS placement can serve as a temporising measure until liver transplantation is feasible, but is not best for the long term. The team also argue for percutaneous portal-vein recanalization when meso-Rex shunting is precluded; early results suggest that in half of such patients, patency can be restored, with good clinical outcomes. Longer-term follow-up is required, however, to assess prognosis and to permit proper counselling.
Literature :
Alberti D et al. Results of a stepwise approach to extrahepatic portal vein obstruction in children. 2013 Nov 57(5):619-626. doi: 10.1097/MPG.0b013e31829fad46. PMID : 23783024
Marra P et al. The role of imaging in portal vein thrombosis: From the diagnosis to the interventional radiological management. Diagnostics (Basel) 2022 Oct 30 12(11):2628. doi: 10.3390/diagnostics12112628. PMID : 36359472, PMCID : PMC9689990
Deniz S et al. Outcome of children with transjugular intrahepatic portosystemic shunt: A meta-analysis of individual patient data. Cardiovasc Intervent Radiol 2023 Sep 46(9):1203-1213. doi: 10.1007/s00270-023-03520-z. Epub 2023 Aug 2. PMID : 37532945, PMCID : PMC10471675
Dr. Marra´s favourite song: Con Le Mani - Zuccero https://open.spotify.com/track/6YyvSHhRZFaoE04mwkw5cY?si=13d7898e636442cc
ESPGHAN favourite Songs can be found on Spotify https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo