Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices: Outcomes and Complications in 49 Patients

Cho, Sung Ki; Shin, Sung Wook; Lee, Inho; Soo, Young; Choo, Sung Wook; Park, Kwang Bo; Yoo, Byung Chul

doi:10.2214/ajr.07.2266

Cited by 114 publications

(147 citation statements)

References 30 publications

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“…Nevertheless, B-RTO is associated with two major complications: early procedure-related complications and late portal hypertensive complications. Procedure-related complications include infection, contrastinduced nephropathy, hematoma formation, pulmonary embolism due to the migration of coils or thrombi, hemolysis and pulmonary edema resulting from the use of ethanolamine oleate iopamidol (22,23). Haptoglobin is usually administered to prevent critical hemolysis, which may cause nephropathy (24,25), as in the present case.…”

Section: Discussionmentioning

confidence: 78%

“…Haptoglobin is usually administered to prevent critical hemolysis, which may cause nephropathy (24,25), as in the present case. Portal hyper-tensive complications due to reperfusion of the shunt vessel flow include the de novo occurrence or aggravation of preexisting gastroesophageal varices or portal hypertensive gastropathy, ascites or spontaneous bacterial peritonitis (22,23,26).…”

Section: Discussionmentioning

confidence: 99%

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Portosystemic Encephalopathy without Liver Cirrhosis Masquerading as Depression

Asakura

Ito

et al. 2015

Intern. Med.

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A 69-year-old woman was hospitalized due to progressive lethargy with hyperammonemia. Five months before the current admission, she was diagnosed with depression based on her low level of daily physical activity and thus began taking antidepressants. Abdominal computed tomography revealed a portosystemic shunt running between the left renal vein and inferior mesenteric vein. Balloon-occluded retrograde transvenous obliteration of the shunt vessel was performed, and the patient showed a remarkable clinical improvement. The possibility of a portosystemic shunt should be considered in the presence or absence of underlying liver disease and the ammonia level should be measured before diagnosing depression, as portosystemic encephalopathy may be reversible with interventional radiology treatment.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Portosystemic Encephalopathy without Liver Cirrhosis Masquerading as Depression

Asakura

Ito

et al. 2015

Intern. Med.

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“…The latter is highly associated with gastric fundal varices. A previous report suggested that [21] , in cases of coexisting gastric fundal varices and esophageal varices in lower esophageal segment, the extent of esophageal varices could be aggravated after imposing obliteration therapy for gastric fundal varices. In our study, there was one patient who experienced alleviation of gastric varices with aggravated para-EV and peri-EV after receiving gastroesophageal varices treatment.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of paraesophageal varices: A study with 64-row multidetector computed tomograghy portal venography

Zhao¹,

He²,

Chen³

2008

WJG

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AIM:To identify the characteristics of morphology, location and collateral circulation involved in paraesophageal varices (para-EV) of portal hypertension patients with 64-row multidetector computed tomography (MDCT). METHODS: Fifty-two of 501 patients with portal hypertensive cirrhosis accompanied with esophageal varices were selected for 64-row MDCT examination after the observation of para-EV. The CT protocol included unenhanced, arterial and portal phases with a slice thickness of 0.625 mm and a scanning field of 2 cm above the bifurcation to the lower edge of kidney. The CT portal venography (CTPV) was reformatted on AW4.3 workstation. The characteristics of origination, location, morphology and collateral circulation in para-EV were observed. RESULTS: Among the 52 cases of para-EV, 50 showed the originations from the posterior branch of left gastric vein, while the others from the anterior branch. Fifty cases demonstrated their locations close to the esophageal-gastric junction, and the other two cases were extended to the inferior bifurcation of the trachea. The circuitous pattern was observed in 16 cases, while reticulated pattern was seen in 36 cases. Collateral circulation identified 4 cases of single periesophageal varices (peri-EV) communication, 3 cases of single hemiazygous vein, one case of single inferior vena cava, 41 cases of mixed type (collateral communications of at least 2 of above mentioned types) and 3 cases of undetermined communications. Among all the cases, 43 patients showed the communications between para-EV and peri-EV, while hemiazygous vein (43 cases) and inferior vena cava (5 cases) were also involved. CONCLUSION: Sixty-four-row multidetector computed tomography portal venography could display the location, morphology, origin, and collateral types of para-EV, which provides important and referable information for clinical management and disease prognosis.

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“…A potentially problematic long-term sequel of B-RTO is the observed development or worsening of esophageal varices in up to 50% of patients [93]. It has been shown that treatment with haptoglobin reduces the risk of hemoglobinuria after B-RTO [94,95]. A recent randomized controlled trial of 20 patients has shown that balloon-occluded endoscopic injection sclerotherapy (BO-EIS) was as effective as B-RTO and required less sclerosant in comparison with B-RTO and was safe for prophylactic treatment of highrisk gastric fundal varices [91].…”

Section: Recommendationsmentioning

confidence: 99%

“…A recent randomized controlled trial of 20 patients has shown that balloon-occluded endoscopic injection sclerotherapy (BO-EIS) was as effective as B-RTO and required less sclerosant in comparison with B-RTO and was safe for prophylactic treatment of highrisk gastric fundal varices [91]. Concomitant hepatocellular carcinoma is the most important prognostic factor after B-RTO [94,95]. It was concluded that primary prophylaxis for high-risk gastric varices would reduce the probability of bleeding and the associated mortality.…”

Section: Recommendationsmentioning

confidence: 99%

Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver

et al. 2008

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The Asian Pacific Association for the Study of the Liver (APASL) set up a Working Party on Portal Hypertension in 2002, with a mandate to develop consensus guidelines on various clinical aspects of portal hypertension relevant to disease patterns and clinical practice in the Asia-Pacific region. Variceal bleeding is a consequence of portal hypertension, which, in turn, is the major complication of liver cirrhosis. Primary prophylaxis to prevent the first bleed from varices is one of the most important strategies for reducing the mortality in cirrhotic patients. Experts predominantly from the Asia-Pacific region were requested to identify the different aspects of primary prophylaxis and develop the consensus guidelines. The APASL Working Party on Portal Hypertension evaluated the various therapies that have been used for the prevention of first variceal bleeding. A 2-day meeting was held on January 12 and 13, 2007, at New Delhi, India, to discuss and finalize the consensus statements. Only those statements that were unanimously approved by the experts were accepted. These statements were circulated to all the experts and were subsequently presented at the annual conference of the APASL at Kyoto, Japan, in March 2007.

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Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices: Outcomes and Complications in 49 Patients

Abstract: Balloon-occluded retrograde transvenous obliteration is an effective treatment for the obliteration of gastric varices. However, application of this procedure to severely compromised patients should be considered carefully.

Cited by 114 publications

References 30 publications

Portosystemic Encephalopathy without Liver Cirrhosis Masquerading as Depression

Portosystemic Encephalopathy without Liver Cirrhosis Masquerading as Depression

Characteristics of paraesophageal varices: A study with 64-row multidetector computed tomograghy portal venography

Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver

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