J Korean Soc Radiol.  2011 Feb;64(2):131-137. 10.3348/jksr.2011.64.2.131.

CT Findings after BRTO in Patients with Gastric Varix Bleeding: Can We Predict Varix Recurrence

• Kim JH
• Kim YH
• An EJ
• Kim SH
• Choi JS

• KMID: 2097928
• DOI: http://doi.org/10.3348/jksr.2011.64.2.131

Abstract

PURPOSE
We wanted to retrospectively evaluate the CT findings after balloon occluded retrograde transvenous obliteration (BRTO) to determine whether the CT findings can predict varix recurrence.
MATERIALS AND METHODS
Of the 48 patients with gastric varix that was bleeding successfully treated with BRTO between February 2004 and November 2008, 35 of them who underwent follow-up endoscopy and CT were enrolled in this study. The morphologic changes of the gastric varix, including gastrorenal shunt and an afferent vein, were evaluated with the use of CT.
RESULTS
Gastric varix recurred in 4 patients and rebleeding occurred in 2. In 22 of 25 patients who underwent CT within 6 months, complete thrombosis of the gastric varix filled with lipiodol was noted, and the gastric varix disappeared without recurrence in all the patients during the long term follow up period. In the other 3 patients who only had thrombosis without lipiodol in the gastric varix, the gastric varices recurred (p=0.0001).
CONCLUSION
The existence of lipiodol, as seen on CT within 6 months after BRTO, was useful to predict complete obliteration of gastric varices without recurrence during the long term follow up period.

MeSH Terms

Balloon Occlusion
Endoscopy
Esophageal and Gastric Varices
Ethiodized Oil
Follow-Up Studies
Gastrointestinal Hemorrhage
Hemorrhage
Humans
Recurrence
Retrospective Studies
Thrombosis
Varicose Veins
Veins
Ethiodized Oil

Figure

• 

  Fig. 1 A 67-year-old male presented with hematemesis. A. CT scan shows gastric varix (arrow) and blood clot in the stomach. B, C. CT scan obtained 2 days after BRTO shows complete thrombosis filled with lipiodol in the gastric varix, posterior gastric vein (arrow) and gastrorenal shunt (arrow head). Ascites is developed after BRTO. D. Seventeen months follow-up CT scan reveals complete obliteration of gastric varix and improvement of ascites.

• 

  Fig. 2 A 71-year-old male presented with hematemesis. A. CT scan shows gastric varix (arrow). B, C. CT scan obtained 11 days after BRTO shows thrombosis of gastric varix without lipiodol uptake (arrow), the posterior gastric D. Seventeen months follow up CT scan shows recurrence of gastric varix (arrow). and he complained of gastric varix rebleeding two months later.

Reference

1. Kim T, Shijo H, Kokawa H, Tokumitsu H, Kubara K, Ota K, et al. Risk factors for hemorrhage from gastric fundal varices. Hepatology. 1997; 25:307–312.

2. Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology. 1992; 16:1343–1349.

3. Idezuki Y. Present status of sclerotherapy and surgical treatment for esophageal varices in Japan. Japanese Research Society for Portal Hypertension and Japanese Research Society for Sclerotherapy of Esophageal Varices. World J Surg. 1992; 16:1193–1120.

4. Kim YH, Seong CK, Kim YJ, Shin TB, Park NH, Choi JS. Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Variceal Bleeding patient. J Korean Radiol Soc. 2003; 48:225–233.

5. Kim ES, Park SY, Kwon KT, Lee DS, Park MJ, Chung IK, et al. The clinical usefulness of balloon occluded retrograde transvenous obliteration in gastric variceal bleeding. Korean J Hepatol. 2003; 9:315–323.

6. Kanagawa H, Mima S, Kouyama H, Mizuo H, Iziri M, Tanabe T, et al. A successfully treated case of fundic varices by retrograde transvenous obliteration with balloon. Nippon Shokakibyo Gakkai Zasshi. 1991; 88:1459–1462.

7. Ninoi T, Nishida N, Kaminou T, Sakai Y, Kitayama T, Hamuro M, et al. Balloon-occluded retrograde transvenous obliteration of gastric varices with gastrorenal shunt: long-term follow-up in 78 patients. AJR Am J Roentgenol. 2005; 184:1340–1346.

8. Fukuda T, Hirota S, Sugimura K. Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy. J Vasc Interv Radiol. 2001; 12:327–336.

9. Kanagawa H, Mima S, Kouyama H, Gotoh K, Uchida T, Okuda K. Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol. 1996; 11:51–58.

10. Sonomura T, Sato M, Kishi K, Terada M, Shioyama Y, Kimura M, et al. Balloon-occluded retrograde transvenous obliteration for gastric varices: a feasibility study. Cardiovasc Intervent Radiol. 1998; 21:27–30.

11. Hirota S, Matsumoto S, Tomita M, Sako M, Kono M. Retrograde transvenous obliteration of gastric varices. Radiology. 1999; 211:349–356.

12. Kiyosue H, Mori H, Matsumoto S, Yamada Y, Hori Y, Okino Y. Transcatheter obliteration of gastric varices. Part 1. Anatomic classification. Radiographics. 2003; 23:911–920.

13. Kawanaka H, Ohta M, Hashizume M, Tomikawa M, Higashi H, Kishihara F, et al. Portosystemic encephalopathy treated with balloon-occluded retrograde transvenous obliteration. Am J Gastroenterol. 1995; 90:508–551.

14. Akahane T, Iwasaki T, Kobayashi N, Tanabe N, Takahashi N, Gama H, et al. Changes in liver function parameters after occlusion of gastrorenal shunts with balloon-occluded retrograde transvenous obliteration. Am J Gastroenterol. 1997; 92:1026–1030.

15. ter Borg PC, Hollemans M, Van Buuren HR, Vleggaar FP, Groeneweg M, Hop WC, et al. Transjugular intrahepatic portosystemic shunts: long-term patency and clinical results in a patient cohort observed for 3-9 years. Radiology. 2004; 231:537–545.

16. LaBerge JM, Somberg KA, Lake JR, Gordon RL, Kerlan RK Jr, Ascher NL, et al. Two-year outcome following transjugular intrahepatic portosystemic shunt for variceal bleeding: results in 90 patients. Gastroenterology. 1995; 108:1143–1151.

17. Sahagun G, Benner KG, Saxon R, Barton RE, Rabkin J, Keller FS, et al. Outcome of 100 patients after transjugular intrahepatic portosystemic shunts for variceal hemorrhage. Am J Gastroenterol. 1997; 92:1444–1452.

18. Jung DJ, Kim PN, Kim TK, Ha HK, Lee MG. Pulsed Wave and Color Doppler US Findings of Transjugular Intrahepatic Portosystemic Shunts (TIPS). J Korean Radiol Soc. 2000; 43:227–231.

19. Choi SK, Shin SW, Yoo EY, Do YS, Park KB, Choo SW, et al. The short-term effects of balloon-occluded retrograde transvenous obliteration for treating gastric varcieal bleeding on portal hypertensive changes: a CT evaluation. Korean J Radiol. 2007; 8:520–530.

20. Kim JH. Medical management of portal hypertension. In : 59th scientific assembly and annual meeting of the Korean Radiological Society categorical course; Korean Society Radiology.