Transcatheter Obliteration of Gastric Varices

Abstract

Since its introduction in the mid-1990s, balloon-occluded retrograde transvenous obliteration (BRTO) has become widely accepted in Japan as a minimally invasive, highly effective treatment for gastric varices. Sufficient filling and stagnation of the sclerosing agent in the entire variceal complex is essential for successful BRTO of gastric varices. However, the success of BRTO in this context also requires familiarity with the hemodynamic features of the varices, including the patterns of their afferent and draining veins, which affect the degree of difficulty in performing BRTO. Thus, accurate assessment of the hemodynamic pattern before and during each procedure is essential for successful treatment. Sixty cases of gastric varices that were successfully treated with transcatheter techniques over the past 5 years were reviewed and analyzed. From this study, a classification system for gastric varices was developed that is based on the hemodynamic pattern of the varices.

The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration

“…Especially in the case of Hirota's grade 3 or 4 varices, 21 additional specialized techniques to treat minor collaterals were utilized. 15,18,21,23,28,30,39,40 If occlusion of minor collateral vessels was necessary, a 50% glucose solution, ethanol, and embolic coils were used. With or without these interventions, a 2.8-French microcatheter (Rapid transit; Johnson and Johnson, New Brunswick, NJ, USA) was introduced through a balloon catheter to the gastric varices, and 2.5-5 ml of 5% ethanolamine oleate was injected intermittently into the gastric varices under fl uoroscopy (Fig.…”

“…3,17,18 If a large spontaneous shunt is present and the portal pressure gradient (as measured by hepatic vein wedge pressure gradient) is <12 mmHg, B-RTO should be considered. 19 However, the majority of reports in the literature pertain to prophylactic treatment, and the long-term outcome after B- RTO has not yet been fully demonstrated.…”

Treatment of bleeding stomal varices by balloon-occluded retrograde transvenous obliteration

“…Moreover, the success of BRTO under these circumstances requires familiarity with the patterns of the variceal afferent and draining veins. 19 In this case, venography revealed an afferent vein from the splenic vein and another from the inferior mesenteric vein, and draining veins into the left superfi cial epigastric vein. We decided to perform the BRTO procedure for this case, because BRTO is similar to but less invasive than PTO.…”

Bleeding Gastric Varices from Liver Cirrhosis Complicated by Hepatocellular Carcinoma Treated by Balloon Occluded Retrograde Transvenous Occlusion Obliteration using Sodium Tetradecyl Sulphate foam in an Emergent Setting

“…Gastric varices can be classified according to the afferent veins (Type 1 to 3) or the draining veins (Type A to D) [3,4]. Type 1 gastric varices are typified by a single afferent gastric vein whilst Type 2, by multiple afferent gastric veins.…”

“…In Type B varices, the outcome of BRTO depends on the number, size and ease by which the collateral draining veins can be occluded. [4] Yamagami et al [6] recently showed that embolisation of collateral veins from gastric varices prior to BRTO is a safe and useful procedure, although they noted that gastric varices with collaterals sufficiently large to necessitate embolisation may require careful follow-up for recurrence. In cases where there are high-flow or large number of draining veins which cannot be occluded, the injected sclerosant will flow into the systemic veins, leading to reduced efficacy of BRTO.…”