Management of gastric fundal varices without gastro-renal shunt in 15 patients.
OBJECTIVE
To examine the portal hemodynamics of gastric fundal varices (GV) without gastro-renal shunt (GRS), and to retrospectively investigate the effects of various kinds of treatment on eradication.


METHODS
Ninety-four liver cirrhosis patients at high-risk of GV were treated in our hospital and enrolled in this study. We retrospectively examined their characteristics, liver function, and portal hemodynamics of GV. We performed balloon-occluded retrograde transvenous obliteration (BRTO) at first. If it was not technically possible to perform BRTO, endoscopic injection sclerotherapy using alpha-cyanoacrylate glue (CA) or percutaneous transhepatic obliteration (PTO) was performed.


RESULTS
Among the 94 patients, a GRS was present in 79 (84.0%), and absent in the remaining 15 (16.0%). The subphrenic vein was connected to the inferior vena cava as the drainage vein in 13 (86.7%) out of the 15 cases without GRS. We performed BRTO in 6 patients, CA in 4 patients and PTO in 5 patients. The eradication rate was 100% for each procedure, but the rate of early recurrence within 6 mo was 16.7% for BRTO, 50.0% for CA and 40.0% for PTO, respectively.


CONCLUSIONS
We should examine the hemodynamics before treatment of GV irrespective of the existence of GRS. If this hemodynamic examination reveals that the drainage vein connects directly to the inferior vena cava in GV without GRS, BRTO may be an effective treatment for GV with GRS.
Kameda
Natsuhiko
N
Second Department of Internal Medicine, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, Japan.
Higuchi
Kazuhide
K
Shiba
Masatsugu
M
Kadouchi
Kaori
K
Machida
Hirohisa
H
Okazaki
Hirotoshi
H
Tanigawa
Tetsuya
T
Watanabe
Toshio
T
Tominaga
Kazunari
K
Fujiwara
Yasuhiro
Y
Nakamura
Kenji
K
Arakawa
Tetsuo
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000473:pathology / Q000601:surgery; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008099:Liver / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical; D012189:Retrospective Studies; D013270:Stomach / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery