Korean J Radiol.  2007 Dec;8(6):520-530. 10.3348/kjr.2007.8.6.520.

The Short-Term Effects of Balloon-Occluded Retrograde Transvenous Obliteration, for Treating Gastric Variceal Bleeding, on Portal Hypertensive Changes: a CT Evaluation

• Cho SK
• Shin SW
• Yoo EY
• Do YS
• Park KB
• Choo SW
• Han H
• Choo IW

• KMID: 1089440
• DOI: http://doi.org/10.3348/kjr.2007.8.6.520

Abstract

OBJECTIVE: We wanted to evaluate the short-term effects of balloon-occluded retrograde transvenous obliteration (BRTO) for treating gastric variceal bleeding, in terms of the portal hypertensive changes, by comparing CT scans. MATERIALS AND METHODS: We enrolled 27 patients who underwent BRTO for gastric variceal bleeding and they had CT scans performed just before and after BRTO. The pre- and post-procedural CT scans were retrospectively compared by two radiologists working in consensus to evaluate the short-term effects of BRTO on the subsequent portal hypertensive changes, including ascites, splenomegaly, portosystemic collaterals (other than gastrorenal shunt), the gall bladder (GB) edema and the intestinal wall edema. Statistical differences were analyzed using the Wilcoxon signed rank test and the paired t-test. RESULTS: Following BRTO, ascites developed or was aggravated in 22 (82%) of 27 patients and it was improved in two patients; the median spleen volumes increased from 438.2 cm3 to 580.8 cm3, and based on a 15% volume change cut-off value, splenic enlargement occurred in 15 (56%) of the 27 patients. The development of new collaterals or worsening of existing collaterals was not observed in any patient. GB wall edema developed or was aggravated in four of 23 patients and this disappeared or improved in five; intestinal wall edema developed or was aggravated in nine of 27 patients, and this disappeared or improved in five. Statistically, we found significant differences for ascites and the splenic volumes before and after BRTO (p = 0.001 and p < 0.001, respectively) CONCLUSION: Some portal hypertensive changes, including ascites and splenomegaly, can be aggravated shortly after BRTO.

Keyword

Abdomen, CT; Hypertension, portal; Interventional procedures; Stomach, varices; Veins, therapeutic embolization

MeSH Terms

Adult
Aged
Aged, 80 and over
Ascites/diagnosis/etiology
Balloon Occlusion/adverse effects/*methods
Cholecystography
Contrast Media/administration & dosage
Edema/diagnosis/etiology
Esophageal and Gastric Varices/complications/*therapy
Female
Follow-Up Studies
Gastrointestinal Hemorrhage/etiology/*therapy
Humans
Hypertension, Portal/*diagnosis/etiology
Intestines/radiography
Iohexol/analogs & derivatives/diagnostic use
Liver Cirrhosis/complications
Male
Middle Aged
Observer Variation
Organ Size
Retrospective Studies
Spleen/radiography
Splenomegaly/diagnosis/etiology
Time Factors
Tomography, X-Ray Computed/*methods
Treatment Outcome

Figure

• 

  Fig. 1 Patient 13. A 63-year-old man with liver cirrhosis who experienced worsening of his ascites, edemas of the GB and intestinal wall and spleen enlargement after balloon-occluded retrograde transvenous obliteration. The serum albumin levels before and after balloonoccluded retrograde transvenous obliteration were 2.3 g/dL and 2.0 g/dL, respectively. A, B. The pre- (A) and post-procedural (B) CT scans at the level of the dome of the liver, obtained 20 hours before balloon-occluded retrograde transvenous obliteration and 66 hours after balloon-occluded retrograde transvenous obliteration, respectively, show the new development of ascites (arrow). His total ascites score increased from zero to 6 after balloon-occluded retrograde transvenous obliteration. C, D. The pre- (C) and post-procedural (D) CT scans at the GB level show the new development of GB edema after balloon-occluded retrograde transvenous obliteration (arrows), in which the maximum GB wall thickness increased from 2 mm to 5 mm. E, F. The pre- (E) and post-procedural (F) CT scans at the level of the right renal hilum show the new development of intestinal wall edema involving the ascending, transverse and descending colon (arrows).

• 

  Fig. 2 Patient 2. A 37-old-year man with liver cirrhosis who experienced the development of ascites and spleen enlargement, but also improvement of his intestinal wall edema and his GB edema disappeared after balloon-occluded retrograde transvenous obliteration. The serum albumin levels before and after balloon-occluded retrograde transvenous obliteration were 2.2 g/dL and 2.8 g/dL, respectively. A, B. Pre- (A) and post-procedural (B) CT scans at the level of the dome of the liver, obtained 18 hours before balloon-occluded retrograde transvenous obliteration and 51 hours after balloon-occluded retrograde transvenous obliteration, respectively, show the development of new bilateral ascites. His total ascites score increased from zero to 8 after balloon-occluded retrograde transvenous obliteration. C, D. The pre- (C) and post-procedural (D) CT scans at the GB level show that the GB edema has disappeared after balloon-occluded retrograde transvenous obliteration (arrows), and there is a reduction in the maximum GB wall thickness from 10 mm to 2 mm. E, F. Diffuse bowel wall thickening (> 6 mm) is evident in the ascending, transverse, and descending colon (arrows) on the pre-procedural CT scans (E), but this is seen only in the ascending colon (arrowhead) on the post-procedural CT scans (F), which indicates that the intestinal wall edema is much improved after balloon-occluded retrograde transvenous obliteration. G, H. The pre- (G) and post-procedural (H) CT scans at the splenic hilum level show splenic enlargement after balloon-occluded retrograde transvenous obliteration. A volume calculation indicated a 120% increase of the spleen volume.

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