The efficacy of balloon-occluded retrograde transvenous obliteration on small intestinal variceal bleeding.
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.
Hashimoto
Naotaka
N
Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Higashi-ku, Fukuoka, Japan. naotakak@surg2.med.kyushu-u.ac.jp
Akahoshi
Tomohiko
T
Yoshida
Daisuke
D
Kinjo
Nao
N
Konishi
Kozo
K
Uehara
Hideo
H
Nagao
Yoshihiro
Y
Kawanaka
Hirofumi
H
Tomikawa
Morimasa
M
Maehara
Yoshihiko
Y
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