Management of gastric fundal varices without gastro-renal shunt in 15 patients

Kameda, Natsuhiko; Higuchi, Kazuhide; Shiba, Masatsugu; Kadouchi, Kaori; Machida, Hirohisa; Okazaki, Hirotoshi; Tanigawa, Tetsuya; Watanabe, Toshio; Tominaga, Kazunari; Fujiwara, Yasuhiro; Nakamura, Kenji

doi:10.3748/wjg.14.448

Cited by 31 publications

(42 citation statements)

References 34 publications

(58 reference statements)

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“…It has been reported that gastrorenal shunts are undetectable in 3-16% of patients with gastric fundal varices [10][11][12]. Kamada et al [12] reported 15 cases of gastric fundal varices with no gastrorenal shunts, and revealed that the main drainage vessels of the varices were the inferior phrenic vein and/or para-esophageal vein in 14 patients and the pericardiophrenic vein in 1 patient.…”

Section: Discussionmentioning

confidence: 97%

A case of gastric varices with gastropericardiac shunt successfully treated by balloon-occluded retrograde transvenous obliteration via the pericardiophrenic vein using a microballoon catheter

Nakazawa

Imai

Inao

et al. 2011

Clin J Gastroenterol

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Gastric fundal varices developed in a 72-year-old female patient with liver cirrhosis due to hepatitis C virus infection after endoscopic injection sclerotherapy for esophageal varices. Three-dimensional computed tomography (CT) imaging demonstrated that gastrorenal shunts were absent as the drainage vessels of the varices, and the blood flows drained mainly into the pericardiophrenic vein. Balloon-occluded retrograde transvenous obliteration (B-RTO) was performed using a microballoon catheter to prevent bleeding from the gastric varices. The left inferior phrenic vein detectable as the second drainage vessel by venography was embolized with metallic coils and ethanolamine oleate solution was injected into the varices following occlusion of blood flow with a microballoon located in the pericardiophrenic vein. CT examination performed 7 days following B-RTO therapy revealed that the blood flow had disappeared with thrombus formation in the varices. B-RTO therapy with a microballoon catheter may be a useful therapy for gastric fundal varices even in cases without gastrorenal shunts, if the main drainage vessels are determined.

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Section: Discussionmentioning

confidence: 97%

A case of gastric varices with gastropericardiac shunt successfully treated by balloon-occluded retrograde transvenous obliteration via the pericardiophrenic vein using a microballoon catheter

Nakazawa

Imai

Inao

et al. 2011

Clin J Gastroenterol

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“…These collateral outflows are antici pated to develop in cases of gastric varices without a G-R shunt. Kameda et al [3] demonstrated that as the draining vessel from gastric varices without a G-R shunt, the sub phrenic vein is the most important followed by the peri cardial vein and paraesophageal vein. In the present study involving a patient with gastric varices without a GR shunt, the inflow vessel was the posterior gastric vein and the outflow vessels were the dilated cardio-phrenic vein and the narrow subphrenic vein.…”

Section: Discussionmentioning

confidence: 99%

“…Gastric varices draining into a G-R shunt occur with a high incidence of 84 to 97% [3,5] . When a G-R shunt, as the main draining vein from gastric varices is present, col lateral outflows such as the left subphrenic vein, pericar diophrenic vein, gonadal vein and retroperitoneal veins are often observed.…”

Section: Discussionmentioning

confidence: 99%

“…Gastric varices most commonly have a spontaneous gastro-renal (G-R) shunt with the left adrenal vein targeted as the main draining vessel by balloon inflation. However, gastric varices which are not associated with a G-R shunt have been observed [3,4] . The outflow vessels of gastric varices without a G-R shunt such as the inferior phrenic vein, cardiophrenic vein, pericardial vein, retroperitoneal vein and intercostal vein are anatomically listed [5] .…”

Section: Introductionmentioning

confidence: 99%

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Balloon-occluded retrograde transvenous obliteration for gastric varicesviathe intercostal vein

Minamiguchi¹,

Kawai²,

Sato³

et al. 2012

WJR

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Gastric varices are usually associated with a gastrorenal (G-R) shunt. However, the gastric varices described in this case report were not associated with a G-R shunt. The inflow vessel was the posterior gastric vein and the outflow vessels were the narrow inferior phrenic vein and the dilated cardio-phrenic vein. First, percutaneous transhepatic obliteration of the posterior gastric vein was performed, but the gastric varices remained patent. Then, micro-balloon catheterization of the subphrenic vein was carried out via the jugular vein, pericardial vein and cardio-phrenic vein, however, micro-balloon-occluded inferior phrenic venography followed by micro-coil embolization of the cardio-phrenic vein revealed no delineation of gastric varices resulting in no further treatment. Thereafter, as a gastrosubphrenic-intercostal vein shunt developed, a microballoon catheter was advanced to the gastric varices via the intercostal vein and balloon-occluded retrograde transvenous obliteration (BRTO) was performed resulting in the eradication of gastric varices. BRTO for gastric varices via the intercostal vein has not previously been documented.

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“…Endovascular obliteration therapy was considered inappropriate for the patient, because of the multiple porto-systemic shunt vessels in the varices and inaccessibility to the veins of Retzius. We did not consider performing percutaneous transhepatic obliteration (PTO), because of its relatively high recurrence rate [4]. Finally, we decided the patient was to receive surgical ligation and sclerotherapy.…”

Section: Case Reportmentioning

confidence: 99%

Usefulness of multi-detector helical CT with multiplanar reconstruction for depicting the duodenal varices with multiple collateral shunt vessels

et al. 2010

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Duodenal varices are a rare complication in patients with portal hypertension. Bleeding from duodenal varices often results in a severe prognosis. Diagnosis of the disease is usually based on findings obtained by endoscopy or angiography. However, it occasionally fails to detect the lesion and demonstrate its porto-systemic shunt vessels which are necessary information to decide an appropriate treatment. Recent advances in CT may make it possible for us to reveal duodenal varices with complicated porto-systemic shunt vessels. We report the case of a 58-year-old man with liver cirrhosis with repeated bleeding from duodenal varices. Esophagogastroduodenoscopy (EGD) revealed multinodular varices in the third portion of the duodenum. Then we conducted a capsule endoscopy (CE) and found fresh blood in the duodenum, suggesting duodenal variceal hemorrhage. Angiography depicted the varices with one afferent and two efferent vessels. Abdominal CT examination was conducted using a fourchannel multi-detector row CT scanner. The multiplanar reconstructed images revealed not only the varices, but also three afferent and two efferent vessels. The patient was treated by surgical ligation and sclerotherapy, because of its complicated porto-systemic shunt and reserved liver function. No gastrointestinal bleeding has been seen after the surgery. Our case suggests the usefulness of multidetector CT with multiplanar reconstruction (MPR) for the diagnosis and therapeutic decision of duodenal varices.

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Management of gastric fundal varices without gastro-renal shunt in 15 patients

Abstract: We should examine the hemodynamics before treatment of GV irrespective of the existence of GRS. If this hemodynamic examination reveals that the drainage vein connects directly to the inferior vena cava in GV without GRS, BRTO may be an effective treatment for GV with GRS.

Cited by 31 publications

References 34 publications

A case of gastric varices with gastropericardiac shunt successfully treated by balloon-occluded retrograde transvenous obliteration via the pericardiophrenic vein using a microballoon catheter

A case of gastric varices with gastropericardiac shunt successfully treated by balloon-occluded retrograde transvenous obliteration via the pericardiophrenic vein using a microballoon catheter

Balloon-occluded retrograde transvenous obliteration for gastric varicesviathe intercostal vein

Usefulness of multi-detector helical CT with multiplanar reconstruction for depicting the duodenal varices with multiple collateral shunt vessels

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