title: Balloon-occluded retrograde transvenous obliteration of gastric fundal varices with hemorrhage.
abstract: 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.
authors.affiliation: First Department of Internal Medicine, Hiroshima University School of Medicine, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
authors.forename: Mikiya
authors.initials: M
authors.lastname: Kitamoto
authors.forename: Michio
authors.initials: M
authors.lastname: Imamura
authors.forename: Koji
authors.initials: K
authors.lastname: Kamada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Aikata
authors.forename: Yoshiiku
authors.initials: Y
authors.lastname: Kawakami
authors.forename: Akiko
authors.initials: A
authors.lastname: Matsumoto
authors.forename: Yoshika
authors.initials: Y
authors.lastname: Kurihara
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Kono
authors.forename: Hiroo
authors.initials: H
authors.lastname: Shirakawa
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakanishi
authors.forename: Katsuhide
authors.initials: K
authors.lastname: Ito
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: 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
chemical_list: D009829:Oleic Acids; D012597:Sclerosing Solutions; C033343:ethanolamine oleate