title: CT portography with gastric variceal volume measurements in the evaluation of endoscopic therapeutic efficacy of tissue adhesive injection into gastric varices: a pilot study.
abstract: BACKGROUND
  N-butyl-2-cyanoacrylate (NBCA) injection is used for treating gastric varices (GV). Determining the degree of obliteration of GV is not readily evident at endoscopy.
  
  
  OBJECTIVE
  The aim of this study was to evaluate CT portography with gastric variceal volume calculations to assess endoscopic therapeutic efficacy of NBCA injection.
  
  
  METHODS
  The study design is a retrospective series pilot study. The setting is a single, tertiary care academic medical center. Ten patients underwent esophagogastroduodenoscopy (EGD) with NBCA injection of GV and had biphasic CT scans performed before and after injection therapy. Based on portal venous images, 3D reconstruction and semi-automated volume calculations of GV were performed. Pre and post injection GV volume calculations were compared.
  
  
  RESULTS
  The mean pre-procedure GV volume was 89.84 cm3. Eight patients had significant improvement in GV volume from pre-treatment versus post-treatment (95.65 cm3 vs. 49.65 cm3, P-value 0.04). Pre-procedure GV volume was not significantly different in patients treated for active hemorrhage versus no hemorrhage (101.66 cm3 vs. 72.11 cm3, P-value 0.33). Two patients had a subsequent GV hemorrhage after NBCA injection. The mean residual GV volume in these patients versus those that did not re-bleed was significantly more (127.77 cm3 vs. 38.00 cm3, P-value 0.005).
  
  
  CONCLUSIONS
  CT portography with measurement of GV volume is a potentially useful tool in determining the therapeutic efficacy NBCA injection of GV. Patients with higher residual GV volumes are at increased risk of hemorrhage and may benefit from repeat injection to reach ideal GV volumes.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, H6/516 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-5124, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Rice
authors.forename: Meghan
authors.initials: M
authors.lastname: Lubner
authors.forename: Andrew
authors.initials: A
authors.lastname: Taylor
authors.forename: Bret J
authors.initials: BJ
authors.lastname: Spier
authors.forename: Adnan
authors.initials: A
authors.lastname: Said
authors.forename: Michael R
authors.initials: MR
authors.lastname: Lucey
authors.forename: Alexandru
authors.initials: A
authors.lastname: Musat
authors.forename: Mark
authors.initials: M
authors.lastname: Reichelderfer
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Pfau
authors.forename: Deepak V
authors.initials: DV
authors.lastname: Gopal
mesh_terms: D000328:Adult; D000368:Aged; D004659:Enbucrilate / Q000008:administration & dosage* / Q000009:adverse effects; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D005773:Gastroscopy; D006801:Humans; D007267:Injections / Q000379:methods; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011172:Portography / Q000379:methods*; D012189:Retrospective Studies; D014014:Tissue Adhesives / Q000008:administration & dosage* / Q000009:adverse effects; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014014:Tissue Adhesives; D004659:Enbucrilate