BRTO assisted endoscopic Histoacryl injection in treating gastric varices with gastrorenal shunt.
OBJECTIVE
We evaluated the feasibility, efficacy and safety of a novel technique of balloon-occluded retrograde transvenous obliteration (BRTO) assisted endoscopic Histoacryl (N-buthyl-2-cyanoacrylate) injection.


METHODS
A total with 11 patients were enrolled and analyzed in this single center, open-label, prospective study. Patients with high-risk gastric varices (defined as fundal varices, large GV (>5 mm), presence of a red spot, and Child-Pugh score C) and concurrent gastrorenal shunt underwent endoscopic Histoacryl injection while the gastrorenal shunt was temporarily occluded with an occlusion balloon. Feasibility, hemostatic effect, intra- and postoperative complications, and varices recurrence were evaluated.


RESULTS
All procedures were successfully done per protocol. Except for one patient who underwent rescue Histoacryl injection due to residual varices, single therapy was sufficient to eliminate gastric varices in ten patients. Intra-operative hemorrhage occurred in one case and was stopped after additional Histoacryl injection. One patient was confirmed to have treatment-related fungemia. No death or major complications occurred, including ectopic embolism, worsening of hepatic and renal function, etc. No recurrence of the varices was found during a median follow-up time (mean ± SD) of 228 ± 153 days.


CONCLUSIONS
BRTO assisted endoscopic Histoacryl injection is effective and safe for patients with high-risk gastric varices and concurrent gastrorenal shunt.
a Medical Center , Tsinghua University , Beijing , China.|b Department of Gastroenterology and Hepatology , Chinese People's Liberation Army General Hospital , Beijing , China.
Qiong
Q
Wu
b Department of Gastroenterology and Hepatology , Chinese People's Liberation Army General Hospital , Beijing , China.
Hua
H
Jiang
b Department of Gastroenterology and Hepatology , Chinese People's Liberation Army General Hospital , Beijing , China.
Enqiang
E
Linghu
c Department of Pathology , University Medical Center of Princeton , Plainsboro , NJ , USA.|d Department of Chemical Biology, Ernest Mario School of Pharmacy , Piscataway , NJ , USA.|e Department of Pathology , Robert Wood Johnson Medical School , New Brunwick , NJ , USA.|f Cancer Institute of New Jersey, Rutgers University , New Brunswick , NJ , USA.
Lanjing
L
Zhang
b Department of Gastroenterology and Hepatology , Chinese People's Liberation Army General Hospital , Beijing , China.
Weifeng
W
Wang
b Department of Gastroenterology and Hepatology , Chinese People's Liberation Army General Hospital , Beijing , China.
Jie
J
Zhang
b Department of Gastroenterology and Hepatology , Chinese People's Liberation Army General Hospital , Beijing , China.
Zhandi
Z
He
b Department of Gastroenterology and Hepatology , Chinese People's Liberation Army General Hospital , Beijing , China.
Juan
J
Wang
b Department of Gastroenterology and Hepatology , Chinese People's Liberation Army General Hospital , Beijing , China.
Yunsheng
Y
Yang
b Department of Gastroenterology and Hepatology , Chinese People's Liberation Army General Hospital , Beijing , China.
Guohui
G
Sun
b Department of Gastroenterology and Hepatology , Chinese People's Liberation Army General Hospital , Beijing , China.|g Department of Gastroenterology and Hepatology , Hainan branch of Chinese PLA General Hospital , Sanya , China.
Gang
G
Sun
D000328:Adult; D000368:Aged; D021721:Balloon Occlusion / Q000379:methods*; D004659:Enbucrilate / Q000008:administration & dosage*; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies
D004659:Enbucrilate
Gastric varices; Histoacryl; balloon-occluded retrograde transvenous obliteration (BRTO); gastrorenal shunt