Balloon-occluded retrograde transvenous obliteration using a microballoon catheter for intractable gastric fundal varices.
OBJECTIVE
Balloon-occluded retrograde transvenous obliteration (B-RTO) is recognized as the standard therapy for patients with gastric fundal varices in Japan; however, the procedure is difficult when drainage veins other than the gastrorenal shunt developed. The efficacy and safety of B-RTO using a microballoon catheter for such patients were evaluated.


METHODS
The subjects were 99 patients with gastric fundal varices who fulfilled the criteria for receiving endoscopic and/or interventional therapies. Among these, 95 patients underwent B-RTO. Of the 95 patients, 14 were treated with the use of microballoon catheters, including nine in whom the left inferior phrenic vein was found as a secondary drainage vein in addition to the gastrorenal shunt, and five in whom a gastrorenal shunt was absent. The B-RTO procedure performed using a microballoon catheter inserted through the left inferior phrenic vein in 13 patients, and through the pericardiophrenic vein in one patient.


RESULTS
The B-RTO procedure using microballoon catheters was successful in 13 of the 14 patients (93%), while in the remaining one patient, multiple drainage veins were visualized on venography. Complete obliteration of the varices was achieved in all the 13 patients by injection of 5% ethanolamine oleate iopamidol at a median volume of 25 mL (range, 11 to 40 mL) through the catheters. None of the patients showed injuries of the drainage veins or any systemic complications.


CONCLUSIONS
B-RTO using a microballoon catheter is useful for the treatment of gastric fundal varices in which drainage veins other than the gastrorenal shunt developed.
Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Iruma-gun, Saitama, Japan.
Yukinori
Y
Imai
Manabu
M
Nakazawa
Satsuki
S
Ando
Kayoko
K
Sugawara
Kazuhiro
K
Hamaoka
Masashi
M
Oka
Satoshi
S
Mochida
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000295:instrumentation / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D005748:Gastric Fundus; D006801:Humans; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000008:administration & dosage; D012597:Sclerosing Solutions / Q000008:administration & dosage; D016896:Treatment Outcome
D009829:Oleic Acids; D012597:Sclerosing Solutions; C033343:ethanolamine oleate
B-RTO; left inferior phrenic vein; microballoon catheter; pericardiophrenic vein