J Korean Radiol Soc.  2003 Mar;48(3):225-233. 10.3348/jkrs.2003.48.3.225.

Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Variceal Bleeding patient

• Kim YH
• Seong CK
• Kim YJ
• Shin TB
• Park NH
• Choi JS

• KMID: 2200046
• DOI: http://doi.org/10.3348/jkrs.2003.48.3.225

Abstract

PURPOSE: To evaluate the technical feasibility and clinical efficacy of balloon-occluded retrograde transvenous obliteration (BRTO) in the treatment of gastric variceal bleeding.
MATERIALS AND METHODS
Between September 2001 and March 2002, ten patients with gastric variceal bleeding and gastrorenal shunt, underwent BRTO. Three of the ten also had hepatic encephalopathy. To evaluate the gastrorenal shunt and exclude portal vein thrombosis, all patients underwent pre-procedural CT scanning. An occlusion balloon catheter was inserted from the right internal jugular vein and on ballooning was wedged into the left adrenal vein. A sclerosing agent (5% ethanolamine oleate-lipiodol mixture) was injected until the varices were completely filled. In four patients, the collateral veins seen at balloon-occluded adrenal venography were embolized with coils prior to sclerotherapy. Post-procedural follow-up CT (n=3) or endoscopy (n=8) was performed 1-4 weeks later, and both before and after the procedure, hepatic function was also monitored.
RESULTS
Treatment was successful in nine cases: the failure involed rupture of the occlusion balloon during inflation, and a transjugular intrahepatic portosystemic shunt was performed. The cessation of bleeding was confirmed endoscopically or clinically; in three patients, follow-up CT showed complete obliteration of the varices. Hepatic function improved in eight patients, but three weeks after the procedure, one expired due to progressive infiltrative hepatoma. The clinical symptoms of the three patients with hepatic encephalopathy showed remarkable improvement.
CONCLUSION
Although more extensive studies and long-term follow up are needed to overcome the limitations of our study, we believe that BRTO is a technically feasible and clinically effective treatment for gastric varices and hepatic encephalopathy.

Keyword

Stomach, varices; Bleeding, therapeutic blockade

MeSH Terms

Carcinoma, Hepatocellular
Catheters
Endoscopy
Esophageal and Gastric Varices*
Ethanolamine
Follow-Up Studies
Hemorrhage
Hepatic Encephalopathy
Humans
Inflation, Economic
Jugular Veins
Phlebography
Portasystemic Shunt, Surgical
Rupture
Sclerotherapy
Tomography, X-Ray Computed
Varicose Veins
Veins
Venous Thrombosis
Ethanolamine