Balloon-occluded retrograde transvenous obliteration of gastric fundal varices with hemorrhage.
OBJECTIVE
This study was performed to evaluate the clinical efficacy, feasibility, and complications of balloon-occluded retrograde transvenous obliteration for patients with hemorrhage from gastric fundal varices.


METHODS
Between December 1994 and February 2001, 24 consecutive patients with hemorrhage from gastric fundal varices were enrolled in this study. Balloon-occluded retrograde transvenous obliteration consisted of injecting 5% ethanolamine oleate iopamidol through the outflow vessels during balloon occlusion. The treatment was performed during acute bleeding in 11 patients and electively in 13 patients. Among those patients with acute bleeding, six were treated for temporary hemostasis with balloon tamponade, and five were treated endoscopically.


RESULTS
Cannulation into the outflow vessels was performed in 23 patients, but the balloon catheter could not be inserted in one patient who had inferior phrenic vein outflow. Complete success was obtained in 88% (21/24) of patients, and partial success was obtained in two patients. In nine of 11 patients with acute bleeding, complete success was achieved. Rebleeding from gastric varices was not observed in patients treated with complete success, whereas two patients treated partially rebled within 1 week of the treatment (rate of rebleeding, 9%). Eradication of gastric varices was obtained in all patients (n = 19) who were examined by endoscopy 3 months after the treatment. Eight patients experienced worsening of esophageal varices. These patients were treated endoscopically because of findings that suggested a risk of hemorrhage. The overall mortality rate was 4% (1/24). No damage to the kidney was observed, although 11 patients had macrohematuria.


CONCLUSIONS
Balloon-occluded retrograde transvenous obliteration followed by any hemostatic procedure might be effective for both prophylaxis of rebleeding and eradication of gastric fundal varices, even in urgent cases.
Kitamoto
Mikiya
M
First Department of Internal Medicine, Hiroshima University School of Medicine, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
Imamura
Michio
M
Kamada
Koji
K
Aikata
Hiroshi
H
Kawakami
Yoshiiku
Y
Matsumoto
Akiko
A
Kurihara
Yoshika
Y
Kono
Hirotaka
H
Shirakawa
Hiroo
H
Nakanishi
Toshio
T
Ito
Katsuhide
K
Chayama
Kazuaki
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000009:adverse effects*; D002404:Catheterization; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005748:Gastric Fundus / Q000000981:diagnostic imaging / Q000187:drug effects*; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006488:Hemostasis, Surgical; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000008:administration & dosage / Q000627:therapeutic use; D011859:Radiography; D019233:Retreatment; D012597:Sclerosing Solutions / Q000008:administration & dosage / Q000627:therapeutic use
D009829:Oleic Acids; D012597:Sclerosing Solutions; C033343:ethanolamine oleate