title: Bleeding gastric varices obliteration with balloon-occluded retrograde transvenous obliteration using sodium tetradecyl sulfate foam.
abstract: OBJECTIVE
  Balloon-occluded retrograde transvenous obliteration (BRTO) of bleeding gastric varices (GV) is well described in the literature. Using ethanolamine oleate as the sclerosing agent in BRTO, but it is not readily available in the United States in the desired concentrations. The authors' aim is to describe their initial experience with BRTO using sodium tetradecyl sulfate (STS) foam as an alternative sclerosing agent.
  
  
  METHODS
  The authors performed a retrospective review of their initial series in which STS foam was used to treat bleeding GV using BRTO. All study subjects had endoscopic evidence of gastric variceal bleeding. STS foam was made using a combination of agents with a 3:2:1 ratio of gas: 3% STS: Lipiodol (Ethiodol; Savage Laboratories, Melville, New York). Mean values and ranges were calculated for each variable, and clinical and imaging outcomes were assessed.
  
  
  RESULTS
  The authors performed BRTO in 22 cirrhotic patients (11 men and 11 women) with a mean age of 52 years (range, 23-83 years). Technical success was achieved in 20 of 22 (91%) patients. Complications occurred in three of 22 (14%) patients. The overall mean dose of STS used was 300 mg (range, 30-600 mg) with mean total volume of sclerosant mixture of 34.1 mL (range, 10-65 mL). Follow-up imaging was available for 18 of 20 (90%) technically successful procedures with a mean period of 89 days (range, 1-359 days). Complete obliteration of GV was achieved in 16 of 18 (89%) patients. There were no cases of recurrent variceal bleeding with a mean clinical follow-up period of 130 days (range, 1-510).
  
  
  CONCLUSIONS
  BRTO utilizing STS foam appears effective in obliterating bleeding GVs with good short-term outcomes.
authors.affiliation: Division of Angiography, Department of Radiology, Box 800170, University of Virginia Health System, Jefferson Park Avenue, Charlottesville, VA 22908, USA. ss2bp@virginia.edu
authors.forename: Saher S
authors.initials: SS
authors.lastname: Sabri
authors.forename: Warren
authors.initials: W
authors.lastname: Swee
authors.forename: Ulku C
authors.initials: UC
authors.lastname: Turba
authors.forename: Wael E A
authors.initials: WE
authors.lastname: Saad
authors.forename: Auh W
authors.initials: AW
authors.lastname: Park
authors.forename: Abdullah M
authors.initials: AM
authors.lastname: Al-Osaimi
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Caldwell
authors.forename: Alan H
authors.initials: AH
authors.lastname: Matsumoto
authors.forename: John F
authors.initials: JF
authors.lastname: Angle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000009:adverse effects; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005773:Gastroscopy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D015911:Sclerotherapy / Q000009:adverse effects; D012981:Sodium Tetradecyl Sulfate / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014680:Veins; D014768:Virginia; D055815:Young Adult
chemical_list: D012597:Sclerosing Solutions; D004998:Ethiodized Oil; D012981:Sodium Tetradecyl Sulfate