Evaluation of Treatment Response after Endoscopic Variceal Obturation with Abdominal Computed Tomography

Abstract

Backgrounds/Aims: Rebleeding of gastric varices (GVs) after endoscopic variceal obturation (EVO) can be fatal. This study was performed to evaluate the usefulness of computed tomography (CT) for the prediction of rebleeding after EVO GV bleeding. Methods: Patients who were treated with EVO for GV bleeding and underwent CT before and after EVO were included. CT images of the portal phase showing pretreatment GVs and feeding vessels, and nonenhanced images showing posttreatment cyanoacrylate impaction were reviewed. Results: Fifty-three patients were included. Their mean age was 60.6±11.6 years, and 40 patients (75.5%) were men. Alcoholic liver disease was the most frequent underlying liver disease (45.3%). Complete impaction of cyanoacrylate in GVs and feeding vessels were achieved in 40 (75.5%) and 24 (45.3%) of patients, respectively. During the follow-up, GV rebleeding occurred in nine patients, and the cumulative incidences of GV rebleeding at 3, 6, and 12 months were 11.8%, 18.9%, and 18.9%, respectively. The GV rebleeding rate did not differ significantly according to the complete cyanoacrylate impaction in the GV, while it differed significantly according to complete cyanoacrylate impaction in the feeding vessels. The cumulative incidences of GV rebleeding at 3, 6, and 12 months were 22.3%, 35.2%, and 35.2%, respectively, in patients with incomplete impaction in feeding vessels, and there was no rebleeding during the follow-up period in patients with complete impaction in the feeding vessels (p=0.002). Conclusions: Abdominal CT is useful in the evaluation of the treatment response after EVO for GV bleeding. Incomplete cyanoacrylate impaction in feeding vessels is a risk factor for GV rebleeding. (Gut Liver 2020;14:117-124)

Two Cases of Fungemia after Endoscopic Variceal Obturation for Gastric Variceal Bleeding

“…Both cases had poor liver function with large size varix, and complete eradication of the feeding vessel was thought to be helpful in reducing the rebleeding risk. 13 14 15 16 For complete obturation of a large varix, multiple injections of cyanoacrylate are required to restrict the amount of cyanoacrylate to less than 1.0 mL per injection and 3.0 mL for each session, considering the risks of embolism or ulcer formation. 6 17 18 Since cyanoacrylate causes acute endovascular necrosis and increased vascular permeability by foreign body reaction, repeated punctures with short intervals could increase the risk of microbial invasion and subsequent blood stream infection, 19 which may contribute to candidemia.…”

Development and internal validation of prediction model for rebleeding within one year after endoscopic treatment of cirrhotic varices: consideration from organ-based CT radiomics signature

“…However, these methods do not directly display EGVs. CT can comprehensively depict the portal venous system and portosystemic collateral vessels, and the varicose veins deep in the mucosa can also be visualized whereas it is di cult to distinguish them from gastric mucosal folds using endoscopy[8, 9] Assessing the portosystemic collaterals, feeding vessels, and variceal volume using CT could help predict EGV rebleeding after endoscopic treatment and might provide important information that would assist in the selection of subsequent endoscopic therapy [10][11][12].…”

Endoscopic variceal obturation and retrograde transvenous obliteration for acute gastric cardiofundal variceal bleeding in liver cirrhosis

“…According to their location, gastroesophageal varices (GOV) 2 and isolated GV (IGV) 1 varices are usually classified as cardiofundal varices [ 7 ]. Treatment of cardiofundal variceal bleeding can be difficult, since cardiofundal varices are larger and have more complicated blood circulation than GOV1s [ 8 – 10 ]. Accompanied collateral shunts are other barriers to achieving a complete cure of cardiofundal varices [ 11 ].…”