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http://dx.doi.org/10.3348/kjr.2016.17.2.230

Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Variceal Hemorrhage  

Chang, Min-Yung (Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine)
Kim, Man-Deuk (Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine)
Kim, Taehwan (Department of Radiology, National Health Insurance Serivce Ilsan Hospital)
Shin, Wonseon (Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine)
Shin, Minwoo (Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine)
Kim, Gyoung Min (Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine)
Won, Jong Yun (Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine)
Park, Sung Il (Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine)
Lee, Do Yun (Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine)
Publication Information
Korean Journal of Radiology / v.17, no.2, 2016 , pp. 230-238 More about this Journal
Abstract
Objective: To evaluate the feasibility, safety, and clinical outcomes of plug-assisted retrograde transvenous obliteration (PARTO) to treat gastric variceal hemorrhage in patients with portal hypertension. Materials and Methods: From May 2012 to June 2014, 19 patients (11 men and 8 women, median age; 61, with history of gastric variceal hemorrhage; 17, active bleeding; 2) who underwent PARTO using a vascular plug and a gelfoam pledget were retrospectively analyzed. Clinical and laboratory data were examined to evaluate primary (technical and clinical success, complications) and secondary (worsening of esophageal varix [EV], change in liver function) end points. Median follow-up duration was 11 months, from 6.5 to 18 months. The Wilcoxon signed-rank test was used to compare laboratory data before and after the procedure. Results: Technical success (complete occlusion of the efferent shunt and complete filling of gastric varix [GV] with a gelfoam slurry) was achieved in 18 of 19 (94.7%) patients. The embolic materials could not reach the GV in 1 patient who had endoscopic glue injection before our procedure. The clinical success rate (no recurrence of gastric variceal bleeding) was the same because the technically failed patient showed recurrent bleeding later. Acute complications included fever (n = 2), fever and hypotension (n = 2; one diagnosed adrenal insufficiency), and transient microscopic hematuria (n = 3). Ten patients underwent follow-up endoscopy; all exhibited GV improvement, except 2 without endoscopic change. Five patients exhibited aggravated EV, and 2 of them had a bleeding event. Laboratory findings were significantly improved after PARTO. Conclusion: PARTO is technically feasible, safe, and effective for gastric variceal hemorrhage in patients with portal hypertension.
Keywords
BRTO; Variceal bleeding; Vascular Plug;
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1 Akahoshi T, Tomikawa M, Kamori M, Tsutsumi N, Nagao Y, Hashizume M, et al. Impact of balloon-occluded retrograde transvenous obliteration on management of isolated fundal gastric variceal bleeding. Hepatol Res 2012;42:385-393   DOI
2 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   DOI
3 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   DOI
4 Kumamoto M, Toyonaga A, Inoue H, Miyakoda K, Morita Y, Emori K, et al. Long-term results of balloon-occluded retrograde transvenous obliteration for gastric fundal varices: hepatic deterioration links to portosystemic shunt syndrome. J Gastroenterol Hepatol 2010;25:1129-1135   DOI
5 Saad WE, Wagner CC, Lippert A, Al-Osaimi A, Davies MG, Matsumoto AH, et al. Protective value of TIPS against the development of hydrothorax/ascites and upper gastrointestinal bleeding after balloon-occluded retrograde transvenous obliteration (BRTO). Am J Gastroenterol 2013;108:1612-1619   DOI
6 Park SJ, Chung JW, Kim HC, Jae HJ, Park JH. The prevalence, risk factors, and clinical outcome of balloon rupture in balloon-occluded retrograde transvenous obliteration of gastric varices. J Vasc Interv Radiol 2010;21:503-507   DOI
7 Hirota S, Matsumoto S, Tomita M, Sako M, Kono M. Retrograde transvenous obliteration of gastric varices. Radiology 1999;211:349-356   DOI
8 Lee JY, Moon SH, Lee SM, Kim HT, Uh S, Kim YH, et al. A case of noncardiogenic pulmonary edema by ethanolamine oleate. Korean J Intern Med 1994;9:125-127   DOI
9 Patel A, Fischman AM, Saad WE. Balloon-occluded retrograde transvenous obliteration of gastric varices. AJR Am J Roentgenol 2012;199:721-729   DOI
10 Uchibori S. [Pulmonary circulatory disturbance following endoscopic injection sclerotherapy]. Nihon Kyobu Shikkan Gakkai Zasshi 1993;31:833-839
11 Gwon DI, Ko GY, Yoon HK, Sung KB, Kim JH, Shin JH, et al. Gastric varices and hepatic encephalopathy: treatment with vascular plug and gelatin sponge-assisted retrograde transvenous obliteration--a primary report. Radiology 2013;268:281-287   DOI
12 Gwon DI, Kim YH, Ko GY, Kim JW, Ko HK, Kim JH, et al. Vascular plug-assisted retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy: a prospective multicenter study. J Vasc Interv Radiol 2015;26:1589-1595   DOI
13 Saad WE, Wagner CC, Al-Osaimi A, Bliebel W, Lippert A, Davies MG, et al. The effect of balloon-occluded transvenous obliteration of gastric varices and gastrorenal shunts on the hepatic synthetic function: a comparison between Child-Pugh and model for end-stage liver disease scores. Vasc Endovascular Surg 2013;47:281-287   DOI
14 Tajiri T, Yoshida H, Obara K, Onji M, Kage M, Kitano S, et al. General rules for recording endoscopic findings of esophagogastric varices (2nd edition). Dig Endosc 2010;22:1-9   DOI
15 Saad WE, Sabri SS. Balloon-occluded retrograde transvenous obliteration (BRTO): technical results and outcomes. Semin Intervent Radiol 2011;28:333-338   DOI
16 de Franchis R, Primignani M. Natural history of portal hypertension in patients with cirrhosis. Clin Liver Dis 2001;5:645-663   DOI
17 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   DOI
18 Triantafyllou M, Stanley AJ. Update on gastric varices. World J Gastrointest Endosc 2014;6:168-175   DOI
19 Lee CH, Lee JH, Choi YS, Paik SW, Sinn DH, Lee CY, et al. [Natural history of gastric varices and risk factors for bleeding]. Korean J Hepatol 2008;14:331-341   DOI
20 Rosolowski M, Hartleb M, Marek T, Milewski J, Linke K, Wallner G, et al. Therapeutic and prophylactic management of bleeding from oesophageal and gastric varices-recommendations of the Working Group of the National Consultant for Gastroenterology. Prz Gastroenterol 2014;9:63-68
21 Saad WE, Darcy MD. Transjugular intrahepatic portosystemic shunt (TIPS) versus balloon-occluded retrograde transvenous obliteration (BRTO) for the management of gastric varices. Semin Intervent Radiol 2011;28:339-349   DOI
22 Khawaja A, Sonawalla AA, Somani SF, Abid S. Management of bleeding gastric varices: a single session of histoacryl injection may be sufficient. Eur J Gastroenterol Hepatol 2014;26:661-667
23 Sonomura T, Ono W, Sato M, Sahara S, Nakata K, Sanda H, et al. Three benefits of microcatheters for retrograde transvenous obliteration of gastric varices. World J Gastroenterol 2012;18:1373-1378   DOI
24 Cho SK, Shin SW, Do YS, Park KB, Choo SW, Kim SS, et al. Development of thrombus in the major systemic and portal veins after balloon-occluded retrograde transvenous obliteration for treating gastric variceal bleeding: its frequency and outcome evaluation with CT. J Vasc Interv Radiol 2008;19:529-538   DOI
25 Lee EW, Saab S, Gomes AS, Busuttil R, McWilliams J, Durazo F, et al. Coil-assisted retrograde transvenous obliteration (CARTO) for the treatment of portal hypertensive variceal bleeding: preliminary results. Clin Transl Gastroenterol 2014;5:e61   DOI
26 Shimoda R, Horiuchi K, Hagiwara S, Suzuki H, Yamazaki Y, Kosone T, et al. Short-term complications of retrograde transvenous obliteration of gastric varices in patients with portal hypertension: effects of obliteration of major portosystemic shunts. Abdom Imaging 2005;30:306-313   DOI
27 Sonomura T, Ono W, Sato M, Sahara S, Nakata K, Sanda H, et al. Emergency balloon-occluded retrograde transvenous obliteration of ruptured gastric varices. World J Gastroenterol 2013;19:5125-5130   DOI
28 Choi YH, Yoon CJ, Park JH, Chung JW, Kwon JW, Choi GM. Balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding: its feasibility compared with transjugular intrahepatic portosystemic shunt. Korean J Radiol 2003;4:109-116   DOI
29 Hashizume M, Kitano S, Yamaga H, Sugimachi K. Haptoglobin to protect against renal damage from ethanolamine oleate sclerosant. Lancet 1988;2:340-341
30 Cho SK, Shin SW, Lee IH, Do YS, Choo SW, Park KB, et al. Balloon-occluded retrograde transvenous obliteration of gastric varices: outcomes and complications in 49 patients. AJR Am J Roentgenol 2007;189:W365-W372   DOI