Safety and Efficacy of Sodium Tetradecyl Sulfate and Lipiodol Foam in Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for Large Porto-Systemic Shunts.
OBJECTIVE
To evaluate the safety and efficacy sodium tetradecyl sulfate and lipiodol foam (STS foam) in BRTO for large (caliber ≥15 mm) porto-systemic shunt and gastric fundal varices.


METHODS
It is a retrospective record-based study of patients who underwent BRTO using STS foam at the Institute of Liver and Biliary Sciences, New Delhi, for gastric variceal bleed or refractory hepatic encephalopathy (HE) who had large porto-systemic shunt (diameter ≥15 mm) with or without associated gastric varices. Clinical and laboratory parameters were evaluated before and after the procedure. All patients were followed for minimum of 12 months.


RESULTS
Records of 22 patients were analyzed. Technical success was achieved in 22 of 22 sessions. Complete obliteration of shunt with clinical improvement was seen in 20 of 22 cases. Patients with gastric varices had no residual gastric varices on follow-up endoscopy. There were significant reduction in CTP scores and improvement in HE grades following BRTO. Post-procedure complication was encountered in 6 patients (5 minor and 1 major), and 7 patients showed worsening of esophageal varices and underwent endoscopic variceal ligation. One patient had succumbed to septicemia at a follow-up of 34 months.


CONCLUSIONS
Our experience suggests STS foam is a safe and effective agent for patients with large shunt undergoing BRTO.
Department of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi, 110070, India.
Amar
A
Mukund
Department of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi, 110070, India. ganeshdeogaonkar@gmail.com.
Ganesh
G
Deogaonkar
Department of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi, 110070, India.
S
S
Rajesh
Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi, 110070, India.
Saggerre Muralikrishna
SM
Shasthry
Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi, 110070, India.
Shiv Kumar
SK
Sarin
D000328:Adult; D000368:Aged; D021721:Balloon Occlusion / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000628:therapy*; D004998:Ethiodized Oil / Q000008:administration & dosage*; D005260:Female; D006501:Hepatic Encephalopathy / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015911:Sclerotherapy / Q000379:methods*; D012981:Sodium Tetradecyl Sulfate / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055682:Viscoelastic Substances
D055682:Viscoelastic Substances; D004998:Ethiodized Oil; D012981:Sodium Tetradecyl Sulfate
BRTO; Gastric varices; Large porto-systemic shunts; Refractory hepatic encephalopathy; STS foam