title: Efficacy of balloon-occluded retrograde transvenous obliteration of large spontaneous lienorenal shunt in patients with severe recurrent hepatic encephalopathy with foam sclerotherapy: initial experience.
abstract: OBJECTIVE
  Balloon-occluded retrograde transvenous obliteration (BRTO) is a widely accepted treatment for gastric varices, but data are limited in regard to its role in the management of hepatic encephalopathy (HE). This study evaluated the efficacy of BRTO with foam sclerotherapy in the management of HE arising as a result of spontaneous large portosystemic shunts.
  
  
  METHODS
  Eight sessions of BRTO with sodium tetradecyl sulfate foam were performed in seven patients with cirrhosis complicated by HE. All patients had portosystemic communication (ie, gastro-/lienorenal shunt) on preprocedure computed tomography. Clinical and laboratory parameters including arterial ammonia level were evaluated in all patients before and after the procedure.
  
  
  RESULTS
  Technical success rates were 86% (six of seven) for the first BRTO session and 100% (one of one) for the second. Follow-up imaging revealed complete obliteration of the varices in five of seven patients (71%) and partial obliteration in the remaining two. Immediate clinical improvement of HE was observed in six of seven patients (86%), with postprocedural decrease in arterial ammonia levels; one patient showed delayed improvement. Procedure-related complications (eg, abnormal liver function test results, acute kidney injury with leukocytosis) were encountered in two patients. All patients showed clinical and symptomatic improvement at the time of discharge and during a follow-up of 4 months (with visits at 1 mo and 3 mo later).
  
  
  CONCLUSIONS
  Initial experience suggests that BRTO is an effective procedure in the management of HE arising as a result of large portosystemic shunts.
authors: Department of Radiology/Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India. dramarmukund@gmail.com
authors: Amar
authors: A
authors: Mukund
authors: S
authors: S
authors: Rajesh
authors: Ankur
authors: A
authors: Arora
authors: Yashwant
authors: Y
authors: Patidar
authors: Deepak
authors: D
authors: Jain
authors: Shiv K
authors: SK
authors: Sarin
mesh_terms: D000368:Aged; D021721:Balloon Occlusion / Q000009:adverse effects / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006501:Hepatic Encephalopathy / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007194:India; D007902:Length of Stay; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012008:Recurrence; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D015911:Sclerotherapy / Q000009:adverse effects; D012720:Severity of Illness Index; D012981:Sodium Tetradecyl Sulfate / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D012597:Sclerosing Solutions; D012981:Sodium Tetradecyl Sulfate