Efficacy of combined balloon-occluded retrograde transvenous obliteration and simultaneous endoscopic injection sclerotherapy.
OBJECTIVE
We evaluated the efficacy and safety of balloon-occluded retrograde transvenous obliteration (B-RTO) performed using absolute ethanol with iodized oil (ET+LPD) and simultaneous endoscopic injection sclerotherapy (EIS) with cyanoacrylate (CA) for gastric varices (GVs).


METHODS
A total of 16 patients with endoscopically proven high-risk GVs treated using combined B-RTO with ET+LPD and EIS with CA between January 2007 and July 2012 were enrolled.


RESULTS
Twelve cases included GVs involving both the cardia and fundus, two cases included fundal varices and two cases included cardiac varices. In terms of the form of GVs, 10 cases involved F2 lesions and six cases involved F3 lesions. The flow vein was the left gastric vein in 13 cases and the posterior gastric vein in three cases. The drainage route was a splenorenal shunt in all cases. The average dose of ET+LPD was 12.0 mL, while that of CA was 2.45 mL. All complications were transient, and no major complications occurred after the procedures. None of the patients experienced bleeding or recurrence of gastric varices after the combined B-RTO and EIS procedures during an average follow-up period of 38.3 months.


CONCLUSIONS
Combined B-RTO with ET+LPD and simultaneous EIS with CA is considered to be an effective and safe procedure for treating GVs.
Department of Gastroenterology, Akita University Graduate School of Medicine, Japan.
Wataru
W
Sato
Kentaro
K
Kamada
Takashi
T
Goto
Shigetoshi
S
Ohshima
Kouichi
K
Miura
Tomomi
T
Shibuya
Takahiro
T
Dohmen
Ryo
R
Kanata
Toshitaka
T
Sakai
Mitsuru
M
Chiba
Yuko
Y
Sugimoto
Shinichiro
S
Minami
Koichi
K
Ishiyama
Manabu
M
Hashimoto
Hirohide
H
Ohnishi
D000328:Adult; D000368:Aged; D021721:Balloon Occlusion / Q000295:instrumentation / Q000379:methods; D003487:Cyanoacrylates / Q000008:administration & dosage; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000628:therapy*; D005260:Female; D005748:Gastric Fundus / Q000473:pathology*; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000628:therapy*; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000008:administration & dosage; D012008:Recurrence; D012307:Risk Factors; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D015911:Sclerotherapy / Q000379:methods; D016896:Treatment Outcome
D003487:Cyanoacrylates; D009829:Oleic Acids; D012597:Sclerosing Solutions; C033343:ethanolamine oleate