Balloon-occluded retrograde transvenous obliteration for gastric varices with gastrorenal or gastrocaval collaterals.
OBJECTIVE
The purpose of this study was to evaluate the efficacy of balloon-occluded retrograde transvenous obliteration for gastric varices with gastrorenal or gastrocaval collaterals.


METHODS
Thirty patients who had gastric varices with gastrorenal or gastrocaval collaterals underwent balloon-occluded retrograde transvenous obliteration. A 5-French balloon catheter was inserted in the gastrorenal collateral, gastrocaval collateral, or both, and a 5% solution of ethanolamine oleate iopamidole that contained equal amounts of ethanolamine oleate and iopamidole 300 was injected into the gastric varices. One day, 1 week, and 1 month after balloon-occluded retrograde transvenous obliteration, hepatic and renal function tests (total bilirubin, transaminase, blood ammonia, serum creatinine, and blood urea nitrogen) were done. To evaluate therapeutic efficacy, we observed the site with endoscopy every 2 weeks and obtained enhanced CT scans every month. The observation time ranged from 10 to 30 months.


RESULTS
After balloon-occluded retrograde transvenous obliteration, gastric varices disappeared completely in all 30 cases in 4-16 weeks (mean, 10 weeks). Recurrence of gastric varices was observed in three cases (10%), which were treated with repeated balloon-occluded retrograde transvenous obliteration. Esophageal varices were aggravated in three patients (10%), who underwent successful endoscopic injection sclerotherapy. Complications of balloon-occluded retrograde transvenous obliteration were fever and hemoglobinuria, which disappeared in about 5 days. We observed no significant hepatic and renal functional damage.


CONCLUSIONS
Balloon-occluded retrograde transvenous obliteration offers good control of gastric varices with gastrorenal or gastrocaval collaterals, even if hepatic function is poor.
Department of Radiology, Sapporo Medical University, Japan.
K
K
Koito
T
T
Namieno
T
T
Nagakawa
K
K
Morita
D000641:Ammonia / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001806:Blood Urea Nitrogen; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D003097:Collateral Circulation / Q000187:drug effects; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003401:Creatine / Q000097:blood; D004932:Esophageal and Gastric Varices / Q000473:pathology / Q000628:therapy*; D005260:Female; D005334:Fever / Q000209:etiology; D005500:Follow-Up Studies; D005773:Gastroscopy; D006456:Hemoglobinuria / Q000209:etiology; D006801:Humans; D007479:Iopamidol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007668:Kidney / Q000503:physiopathology; D008099:Liver / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012008:Recurrence; D012077:Renal Artery / Q000473:pathology*; D012597:Sclerosing Solutions / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*; D013270:Stomach / Q000098:blood supply; D014057:Tomography, X-Ray Computed; D000637:Transaminases / Q000097:blood; D014682:Vena Cava, Inferior / Q000473:pathology*
D003287:Contrast Media; D009829:Oleic Acids; D012597:Sclerosing Solutions; D000641:Ammonia; D000637:Transaminases; D007479:Iopamidol; D003401:Creatine; D001663:Bilirubin; C033343:ethanolamine oleate