title: The efficacy of balloon-occluded retrograde transvenous obliteration on small intestinal variceal bleeding.
abstract: BACKGROUND
  Small intestinal variceal bleeding is an unusual cause of gastrointestinal hemorrhaging of portal hypertensive patients, but once it occurs it may lead to life-threatening bleeding because this problem is difficult to diagnose and treat. This study investigated the efficacy of balloon occluded retrograde transvenous obliteration (B-RTO) to treat small intestinal variceal bleeding.
  
  
  METHODS
  From 2003 to 2007, 6 patients with small variceal bleeding were treated by B-RTO. The characteristics of the patients, B-RTO procedures, prognosis, and occurrence of risky esophageal and gastric varices were evaluated according to their medical records.
  
  
  RESULTS
  Three-dimensional (3-D) angiography by MD-CT was useful for the diagnosis of small intestinal varices and the draining vessels. In all cases, variceal bleeding was controlled by B-RTO treatment, although rebleeding was recognized in one patient after 30 months (16.6%). All patients were alive throughout the follow-up except 1 patient who died of liver failure (6-44 months). Risky esophageal varices and gastric varices occurred in 2 patients (33.3%) after B-RTO. However, no variceal bleeding occurred.
  
  
  CONCLUSIONS
  B-RTO was found to be an effective treatment modality which provided good initial hemostasis, thereby eradicating ectopic small intestinal varices.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Higashi-ku, Fukuoka, Japan. naotakak@surg2.med.kyushu-u.ac.jp
authors.forename: Naotaka
authors.initials: N
authors.lastname: Hashimoto
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Akahoshi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yoshida
authors.forename: Nao
authors.initials: N
authors.lastname: Kinjo
authors.forename: Kozo
authors.initials: K
authors.lastname: Konishi
authors.forename: Hideo
authors.initials: H
authors.lastname: Uehara
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nagao
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawanaka
authors.forename: Morimasa
authors.initials: M
authors.lastname: Tomikawa
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D021721:Balloon Occlusion / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D007421:Intestine, Small / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D014648:Varicose Veins / Q000150:complications* / Q000000981:diagnostic imaging