Balloon-Occluded Retrograde Transvenous Obliteration of High Risk Gastric Fundal Varices

Matsumoto, Akio; Hamamoto, Norihiro; Nomura, Toshiyuki; Hongou, Yasushi; Arisaka, Yoshifumi; Morikawa, Hiroshi; Hirata, Ichiro; Katsu, Ken‐ichi

doi:10.1111/j.1572-0241.1999.00928.x

Cited by 115 publications

(79 citation statements)

References 23 publications

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“…19 However, the majority of reports in the literature pertain to prophylactic treatment, and the long-term outcome after B- RTO has not yet been fully demonstrated. 14,16,[20][21][22][23][24] In the present study, we describe the long-term outcome of patients with bleeding from gastric varices after B-RTO. In addition, we review the literature on the usefulness of B-RTO in the treatment of gastric varices with hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration

et al. 2007

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Section: Introductionmentioning

confidence: 99%

The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration

et al. 2007

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“…17 Balloon occluded retrograde transvenous obliteration has been used successfully for GV obliteration, primarily in Japan, as an elective procedure, but is unsuitable for acute gastric variceal bleeding and requires the presence of a spontaneous gastro-renal shunt. 21 The preferred first line treatment for acute gastric variceal bleeding is endoscopic obliteration with NBC. 20,22 Endoscopic injection of tissue glue for gastric variceal bleeding was first reported in 1986 by Soehendra et al 12 Since then, this method has been adopted widely and proved to be effective in the hemostasis of gastric variceal bleeding.…”

Section: Discussionmentioning

confidence: 99%

Gastric Varices in Cirrhosis versus Extrahepatic Portal Venous Obstruction and Response to Endoscopic N-Butyl-2-cyanoacrylate Injection

Sharma

Banka

Rawat

et al. 2013

Journal of Clinical and Experimental Hepatology

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Background: Gastric varices are found in patients with portal hypertension. Incidence of bleeding from gastric varices is relatively low, but tends to be more severe, and is associated with higher mortality than esophageal variceal bleeding. Aims and objectives: To compare the prevalence and types of gastric varices in cirrhosis versus extrahepatic portal venous obstruction (EHPVO) and the results of endoscopic N-butyl-2-cyanoacrylate (NBC, glue) injection. Methods: Eighty six patients presenting with bleeding from gastric varices between August 2010 and August 2011 were retrospectively analyzed. Results: Of 86 patients, 65% (n = 56) were cirrhotics and 35% (n = 30) had EHPVO. Distribution of types of gastric varices showed GOV1 in 14% (n = 8) of cirrhotics vs. 7% (n = 2) of EHPVO, GOV2 in 80% (n = 45) of cirrhotics vs. 53% (n = 16) of EHPVO, IGV1 in 40% (n = 12) of patients with EHPVO vs. 4% (n = 2) cirrhotics. The patients were treated with NBC injections. The mean volume of glue injected was 3.7 ± 2.58 ml over a median of 1 session (range: 1-8). The total volume of glue required was lower in cirrhotics (3.2 ± 2 ml vs. 4.7 ± 3.1 ml, p < 0.05) than in EHPVO patients. Twenty (36%) of cirrhotics required >1 sessions of glue injection as compared to 17 (57%) of EHPVO patients. Over mean follow up of 12 months, rebleeding (9% vs. 10%) and mortality (11% vs. 3%) were similar in patients with cirrhosis and EHPVO. Conclusions: In patients with bleeding from gastric varices, GOV2 is more common in cirrhotics and IGV1 in patients with EHPVO. Patients with EHPVO required higher total volume of glue and more glue sessions for gastric varix obturation. ( J CLIN EXP HEPATOL 2013;3:19-23)

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“…Balloon-occluded retrograde transvenous obliteration (B-RTO) has been reported to be a feasible treatment for gastric fundal varices, with a high rate of complete eradication (85%-100%), and prophylactic B-RTO is widely used in Japan. [3][4][5][6][7] B-RTO is safe; however, crucial complications such as gastric mucosal damage have also been reported. 8 We herein describe a case of deep gastric ulceration after prophylactic B-RTO.…”

Section: Introductionmentioning

confidence: 99%

Gastric ulcer after prophylactic balloon-occluded retrograde transvenous obliteration

et al. 2007

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A 74-year-old man with compensated hepatitis C virus-related liver cirrhosis was admitted for the treatment of small hepatocellular carcinoma (HCC) by radiofrequency ablation therapy (RFA). As a routine pretreatment examination, gastrointestinal endoscopy was performed, and large nodular varices were observed in the gastric fornix, with telangiectasia on top of the varices. As soon as the RFA was completed, prophylactic balloon-occluded retrograde transvenous obliteration (B-RTO) was performed. Seven days after the B-RTO, the patient complicated of upper abdominal pain. Gastrointestinal endoscopy was performed, and a deep ulcer, located at the top of the tumor-shaped gastric varices, was found. The ulcer showed rapid healing after 1-week administration of a proton pump inhibitor (PPI). A severe ulcer after a B-RTO procedure, is extremely rare, because sclerosing agents rarely flow into the gastric mucosa. The ulcer in this patient was deep and large, and it may have been due to direct mucosal damage caused by the sclerosing agent, because mucosal telangiectasia on top of the varices was observed before the B-RTO. It is likely that, in this patient, the mucosal vessels communicated with the submucosal large varices, and ethanolamine oleate (EOI) flowed into the gastric mucosa via this communication. Based on our experience, we recommend periodic follow-up endoscopy.

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Balloon-Occluded Retrograde Transvenous Obliteration of High Risk Gastric Fundal Varices

Abstract: This procedure was effective for treating gastric fundal varices. However, type Ib patients are likely to develop high risk esophageal varices after occlusion of the gastrorenal shunt.

Cited by 115 publications

References 23 publications

The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration

The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration

Gastric Varices in Cirrhosis versus Extrahepatic Portal Venous Obstruction and Response to Endoscopic N-Butyl-2-cyanoacrylate Injection

Gastric ulcer after prophylactic balloon-occluded retrograde transvenous obliteration

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