Fusion of Interventional Radiology with Surgery and Endoscopy to Advance Therapies in Complex Gastrointestinal Disease.

Abstract

Interventional radiology techniques using image guidance have revolutionized healthcare by enabling less invasive approaches for "difficult-to-treat" conditions. Complex gastrointestinal (GI) conditions such as bowel obstructions, enterocutaneous fistulas, and other enteric maladies are major causes of morbidity and mortality; are rising in incidence worldwide; and may benefit from the integration of interventional radiology techniques into current surgical/endoscopic management strategies, analogous to cardiovascular interventions of the past few decades. Conservative medical management of these intestinal conditions can fail or result in extended hospital admissions and poor quality of life, while current operative management can be fraught with complications and death, especially in high-risk patients with prior abdominal surgeries. The prevalence of GI conditions requiring intervention and the potential for complications and morbidity with current methods, including laparoscopy, suggests that this is a field ripe for innovation. This article outlines an innovative approach to managing complex GI problems that we are developing at our institution, combining interventional radiological techniques with advanced surgical/endoscopic methods. Specifically, we attempt to highlight the benefits of a multidisciplinary team using advanced imaging guidance to perform novel percutaneous, endoscopic, and surgical procedures for high-surgical risk patients with intestinal problems requiring intervention.