Balloon-occluded retrograde transvenous obliteration for intractable gastric variceal bleeding.
Balloon-occluded retrograde transvenous obliteration (BRTO) is an interventional radiologic technique that obliterates gastric varices (GV) from draining veins under balloon occlusion. A 54-year-old man presented with Stage IV hepatocellular carcinoma and tumor thrombi in main portal vein. Intractable GV bleeding had no response to repeated endoscopic sclerotherapy and pharmacotherapy well. Additionally, his medical condition could not allow transjugular intrahepatic portosystemic shunt or surgical portal decompression. Due to spontaneous gastrorenal shunt proved with abdominal computed tomography, we conducted BRTO to prevent further bleeding. The immediate postprocedural venogram showed total occlusion of the gastrorenal shunt and no visualization of the GV. Follow-up endoscopy was performed at 1 month, 2 months, and 4 months after BRTO. It revealed shrinkage of gastric varices and no worsening of esophageal varices after 4 months of BRTO. The patient was free from repeated GV bleeding for 4 months. Our experience proved BRTO could be the other effective treatment for intractable GV bleeding.
Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC.
Tsung-Jung
TJ
Liang
Yu-Chia
YC
Chen
Huei-Lung
HL
Liang
Shiuh-Inn
SI
Liu
Po-Min
PM
Chang
D021721:Balloon Occlusion; D006528:Carcinoma, Hepatocellular / Q000150:complications; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D020246:Venous Thrombosis
balloon-occluded retrograde transvenous obliteration; gastric varices; gastrorenal shunt; sclerotherapy