title: Emergency balloon-occluded retrograde transvenous obliteration of ruptured gastric varices.
abstract: OBJECTIVE
  To evaluate the effectiveness and safety of emergency balloon-occluded retrograde transvenous obliteration (BRTO) for ruptured gastric varices.
  
  
  METHODS
  Emergency BRTO was performed in 17 patients with gastric varices and gastrorenal or gastrocaval shunts within 24 h of hematemesis and/or tarry stool. The gastric varices were confirmed by endoscopy, and the gastrorenal or gastrocaval shunts were identified by contrast-enhanced computed tomography (CE-CT). A 6-Fr balloon catheter (Cobra type) was inserted into the gastrorenal shunt via the right internal jugular vein, or into the gastrocaval shunt via the right femoral vein, depending on the varices drainage route. The sclerosant, 5% ethanolamine oleate iopamidol, was injected into the gastric varices through the catheter during balloon occlusion. In patients with incomplete thrombosis of the varices after the first BRTO, a second BRTO was performed the following day. Patients were followed up by endoscopy and CE-CT at 1 d, 1 wk, and 1, 3 and 6 mo after the procedure, and every 6 mo thereafter.
  
  
  RESULTS
  Complete thrombosis of the gastric varices was not achieved with the first BRTO in 7/17 patients because of large gastric varices. These patients underwent a second BRTO on the next day, and additional sclerosant was injected through the catheter. Complete thrombosis which led to disappearance of the varices was achieved in 16/17 patients, while the remaining patient had incomplete thrombosis of the varices. None of the patients experienced rebleeding or recurrence of the gastric varices after a median follow-up of 1130 d (range 8-2739 d). No major complications occurred after the procedure. However, esophageal varices worsened in 5/17 patients after a mean follow-up of 8.6 mo.
  
  
  CONCLUSIONS
  Emergency BRTO is an effective and safe treatment for ruptured gastric varices.
authors: Department of Radiology, Wakayama Medical University, Wakayama 641-8510, Japan. sonomura@wakayama-med.ac.jp
authors: Tetsuo
authors: T
authors: Sonomura
authors: Wataru
authors: W
authors: Ono
authors: Morio
authors: M
authors: Sato
authors: Shinya
authors: S
authors: Sahara
authors: Kouhei
authors: K
authors: Nakata
authors: Hiroki
authors: H
authors: Sanda
authors: Nobuyuki
authors: N
authors: Kawai
authors: Hiroki
authors: H
authors: Minamiguchi
authors: Motoki
authors: M
authors: Nakai
authors: Kazushi
authors: K
authors: Kishi
mesh_terms: D000328:Adult; D000368:Aged; D021721:Balloon Occlusion / Q000009:adverse effects; D004630:Emergencies; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006396:Hematemesis / Q000209:etiology; D006801:Humans; D008297:Male; D008551:Melena / Q000209:etiology; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Bleeding; Emergency balloon-occluded retrograde transvenous obliteration; Ethanolamine oleate; Gastric varices; Portal hypertension
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