| The Clinical Usefulness of Balloon Occluded Retrograde Transvenous Obliteration in Gastric Variceal Bleeding |
| Eun Soo Kim, M.D., Soo Young Park, M.D., Ki Tae Kwon, M.D., Dong Seok Lee, M.D.,
Min Jae Park, M.D., In Kwon Chung, M.D., Jin Hyung Park, M.D., Chang Min Cho, M.D.,
Won Young Tak, M.D., Young Oh Kweon, M.D., Sung Kook Kim, M.D., Yong Whan Choi, M.D.
and Chang Kyu Seong, M.D.1 |
| Department of Internal Medicine, Department of Radiology1, Kyungpook National University, College of Medicine, Daegu, Korea |
|
|
|
|
| ABSTRACT |
|
Backgrounds/Aims
Gastric variceal bleeding is difficult to treat endoscopically because the hemodynamics
of the gastric varix are different from that of the esophageal varix. Transjugular intrahepatic portosystemic shunt
(TIPS), which has been used widely, does not always result in the regression of gastric varix and it may
aggravate the hepatic encephalopathy. Balloon occluded retrograde transvenous obliteration (BRTO) was
introduced as a new procedure for gastric variceal bleeding with minimal invasiveness. The purpose of this study
was to evaluate the therapeutic effects and complications on follow-up of BRTO as a new treatment option
for gastric variceal bleeding. Methods: Patients with gastric variceal bleeding, who were treated with BRTO
form September, 2001 to April, 2003, were included in the study. After the definite confirmation of the shunts
with abdominal CT, the sclerosing agent, 5% ethanolamine oleate, was injected into the gastric varix during
occlusion through gastrorenal shunts. The procedurre was deemed a technical success when the clotting of the
sclerosing agent was observed without leakage, and a clinical success when bleeding stopped and the varix
decreased in size or was eradicated during the follow-up period (6-23 months, mean: 17.7). Results: Technical
success was achieved in 12 of 13 patients (92%) with gastric variceal bleeding. There were no significant side
effects. In the one case of failure, the bleeding was controlled with TIPS. Eleven of the 12 patients who had
technical success were shown to be clinically successful. The follow-up endoscopic exam showed some
aggravation of pre-existing esophageal varices in four patients and a new development of esophageal varices
in two patients. Endoscopic variceal ligation was done on one patient in whom esophageal variceal bleeding was
present during the follow-up period. Conclusions: BRTO was proven to be a feasible, safe and less invasive
procedure than TIPS and found to be an effective treatment of a gastric variceal bleeding. Considering the
possible aggravation of pre-existing esophageal varices or the new development of esophageal varices, regular
endoscopic examinations might be needed during the follow-up period.(Korean J Hepatol 2003;9:315-323) |
| KeyWords:
Balloon occluded retrograde transvenous obliteration, Varix/Gastric, Transjugular
intrahepatic portosystemic shunt |
|
|
PDF Links
Full text via DOI
Download Citation
