title: Respiratory effects of balloon occluded retrograde transvenous obliteration of gastric varices: a prospective controlled study.
abstract: OBJECTIVE
  We evaluated the respiratory effects of balloon-occluded retrograde transvenous obliteration (BRTO) performed for the treatment of gastric varices complicating liver cirrhosis.
  
  
  METHODS
  From 2005 to 2009, we performed BRTO in 20 patients with gastric fundal varices, by intravariceal injection of 5% ethanolamine oleate (EO) as the sclerosant. We studied the effect of BRTO on the respiratory gas exchange, chest X-ray findings, computed tomography (CT) findings, pulmonary function parameters, and (99m) Tc-MAA lung perfusion scintigraphy findings. Subjects undergoing balloon-occluded retrograde transvenous varicerography (BRTV) without injection of the sclerosant served as the controls.
  
  
  RESULTS
  Arterial blood gas analysis revealed a decrease in the mean arterial partial oxygen tension (PaO(2)) (P < 0.01), and increase in the alveolar-arterial oxygen tension difference (AaDO(2)) after BRTO (P < 0.01), as compared with the results obtained before the BRTO, while breathing room air. No changes were observed after BRTV as compared with the previous findings. In addition, a significant correlation was observed between the change of the PaO(2) and the volume of the sclerosant injected (rs = 0.511, P = 0.011). Left-pleural effusion was noted on the chest CT in 20% of the patients. On pulmonary function testing, decrease of the vital capacity was noted in two of the 20 patients after BRTO.
  
  
  CONCLUSIONS
  The aforementioned results suggest that BRTO performed using EO as the sclerosant induces pulmonary function disorders. The effect was found to depend on the total amount of EO injected. Therefore, careful respiratory monitoring seems necessary in patients undergoing BRTO, particularly those in whom large volumes of the sclerosant are used.
authors: Department of Gastroenterology, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan. h-arai@maebashi.jrc.or.jp
authors: Hirotaka
authors: H
authors: Arai
authors: Takehiko
authors: T
authors: Abe
authors: Hisashi
authors: H
authors: Takayama
authors: Mitsuo
authors: M
authors: Toyoda
authors: Kazuyo
authors: K
authors: Mori
authors: Takashi
authors: T
authors: Ueno
authors: Hitoshi
authors: H
authors: Takagi
authors: Ryuya
authors: R
authors: Shimoda
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D021721:Balloon Occlusion / Q000009:adverse effects; D016022:Case-Control Studies; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology*; D015552:Injections, Intralesional; D007564:Japan; D008103:Liver Cirrhosis / Q000150:complications*; D008168:Lung / Q000503:physiopathology; D008171:Lung Diseases / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D010100:Oxygen / Q000097:blood; D010996:Pleural Effusion / Q000209:etiology; D011659:Pulmonary Gas Exchange; D012597:Sclerosing Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014797:Vital Capacity
chemical_list: D009829:Oleic Acids; D012597:Sclerosing Solutions; D010100:Oxygen; C033343:ethanolamine oleate