title: Control of isolated gastric varices by combination therapy using embolization and endoscopic scleroligation therapy.
abstract: Balloon-occluded retrograde venous obliteration is a powerful new technique for eliminating gastric varices. However anatomic considerations may preclude its use in some instances. Two cases are reported in which combination embolization followed by endoscopic injection scleroligation therapy eradicated isolated gastric varices where balloon-occluded retrograde venous obliteration was impossible. Two men with alcoholic cirrhosis were admitted with bleeding gastric varices. Inability to access variceal venous drainage precluded balloon-occluded retrograde venous obliteration. In Case 1, transileocolic vein obliteration left gastric embolization, and partial splenic embolization only partially eradicated gastric varices. In Case 2, percutaneous transhepatic obliteration, left gastric embolization, and partial splenic embolization were only partially successful. In both cases, endoscopic injection scleroligation therapy was performed adjunctively. Endoscopic injection scleroligation therapy completely eradicated gastric varices in both patients following partially successful embolization therapy. These cases demonstrate the importance of individualizing treatment of esophageal varices, the value of combination therapy, and the effectiveness of endoscopic injection scleroligation therapy for treating varices.
authors.affiliation: First Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Yoshioka
authors.forename: Masahiko
authors.initials: M
authors.lastname: Onda
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
authors.forename: Koho
authors.initials: K
authors.lastname: Akimaru
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Mamada
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Taniai
authors.forename: Sho
authors.initials: S
authors.lastname: Mineta
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirakata
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kumazaki
mesh_terms: D000368:Aged; D021721:Balloon Occlusion; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000628:therapy*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008026:Ligation / Q000379:methods; D008104:Liver Cirrhosis, Alcoholic / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011172:Portography; D012086:Reoperation; D015911:Sclerotherapy / Q000379:methods*; D016896:Treatment Outcome