Eradication of large gastric varices by sclerotherapy combined with percutaneous transhepatic obliteration.
OBJECTIVE
The long-term results of a combination therapy of sclerotherapy with percutaneous transhepatic obliteration (PTO) was reviewed in 37 patients with large gastric varices. The study suggests that sclerotherapy combined with PTO can safely and effectively eradicate large gastric varices as an alternative approach to surgery. Complete eradication has also been shown to prevent the recurrence of gastric varices.


METHODS
The long-term results of a combination therapy of sclerotherapy with PTO was reviewed in 37 patients with large gastric varices.


RESULTS
Complete eradication of the gastric varices was obtained in 26 patients (70.3%). There was no recurrence of the varices in whom complete eradication had been obtained, but in 11 patients with incomplete eradication gastric varices recurred during the mean follow-up period of 37.5 months. Bleeding occurred in 4 after the treatment and one patient died of massive bleeding from the recurrent gastric varices. There were no major complications with the procedure except for one who had a peripheral pulmonary arterial embolization as a result of a steel coil used for the PTO.


CONCLUSIONS
This study suggests that sclerotherapy combined with PTO can effectively and safely eradicate large gastric varices and is an alternative approach to surgery for treating patients with gastric varices. It is also shown that complete eradication leads to a prevention of recurrence of gastric varices.
Hashizume
M
M
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Tsugawa
K
K
Migo
S
S
Tomikawa
M
M
Kishihara
F
F
Kawanaka
H
H
Tanoue
K
K
Ohta
M
M
Sugimachi
K
K
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications; D003131:Combined Modality Therapy; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015911:Sclerotherapy / Q000379:methods*