Efficacy of Combined Balloon-occluded Retrograde Transvenous Obliteration and Simultaneous Endoscopic Injection Sclerotherapy

Abstract

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. Conclusion Combined B-RTO with ET+LPD and simultaneous EIS with CA is considered to be an effective and safe procedure for treating GVs.

Isolated Gastric Varices Refractory to Balloon-occluded Retrograde Transvenous Obliteration (BRTO) Successfully Treated by Shunt-occluded Endoscopic Injection Sclerotherapy (SO-EIS): A Case Report and Review of the Literature

“…SO-EIS is a treatment for IGVs using endoscopic injection sclerotherapy (EIS) after temporary major shunt occlusion by a balloon catheter to cause stagnation of the blood flow (10-14). A previous study reported that the technical success rate was 90-100%, with no serious complications observed, although the number of cases in whom this procedure had been performed were limited.…”

“…Further complicating matters is the lack of an optimal secondary treatment for IGVs refractory to BRTO. One proposed alternative treatment is shunt-occluded endoscopic injection sclerotherapy (SO-EIS) (10-14), which is a combination therapy of major shunt occlusion by a balloon catheter and endoscopic injection sclerotherapy. However, the efficacy and safety of SO-EIS for IGVs refractory to BRTO are unclear.…”