Brief Article
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World J Gastroenterol. Aug 21, 2013; 19(31): 5125-5130
Published online Aug 21, 2013. doi: 10.3748/wjg.v19.i31.5125
Emergency balloon-occluded retrograde transvenous obliteration of ruptured gastric varices
Tetsuo Sonomura, Wataru Ono, Morio Sato, Shinya Sahara, Kouhei Nakata, Hiroki Sanda, Nobuyuki Kawai, Hiroki Minamiguchi, Motoki Nakai, Kazushi Kishi
Tetsuo Sonomura, Morio Sato, Kouhei Nakata, Hiroki Sanda, Nobuyuki Kawai, Hiroki Minamiguchi, Motoki Nakai, Kazushi Kishi, Department of Radiology, Wakayama Medical University, Wakayama 641-8510, Japan
Wataru Ono, Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada 596-8522, Japan
Shinya Sahara, Department of Radiology, Kishiwada Tokushukai Hospital, Kishiwada 596-8522, Japan
Author contributions: Sonomura T designed the research; Sonomura T, Ono W, Sahara S, Nakata K and Sanda H performed the clinical study; Sonomura T, Kawai N, Minamiguchi H and Nakai M acquired data and researched the literature; Sonomura T, Sato M and Kishi K drafted the manuscript and edited it.
Correspondence to: Tetsuo Sonomura, MD, PhD, Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan.
Telephone: +81-73-4410605 Fax: +81-73-4443110
Received: May 13, 2013
Revised: June 13, 2013
Accepted: July 4, 2013
Published online: August 21, 2013

AIM: To evaluate the effectiveness and safety of emergency balloon-occluded retrograde transvenous obliteration (BRTO) for ruptured gastric varices.

METHODS: Emergency BRTO was performed in 17 patients with gastric varices and gastrorenal or gastrocaval shunts within 24 h of hematemesis and/or tarry stool. The gastric varices were confirmed by endoscopy, and the gastrorenal or gastrocaval shunts were identified by contrast-enhanced computed tomography (CE-CT). A 6-Fr balloon catheter (Cobra type) was inserted into the gastrorenal shunt via the right internal jugular vein, or into the gastrocaval shunt via the right femoral vein, depending on the varices drainage route. The sclerosant, 5% ethanolamine oleate iopamidol, was injected into the gastric varices through the catheter during balloon occlusion. In patients with incomplete thrombosis of the varices after the first BRTO, a second BRTO was performed the following day. Patients were followed up by endoscopy and CE-CT at 1 d, 1 wk, and 1, 3 and 6 mo after the procedure, and every 6 mo thereafter.

RESULTS: Complete thrombosis of the gastric varices was not achieved with the first BRTO in 7/17 patients because of large gastric varices. These patients underwent a second BRTO on the next day, and additional sclerosant was injected through the catheter. Complete thrombosis which led to disappearance of the varices was achieved in 16/17 patients, while the remaining patient had incomplete thrombosis of the varices. None of the patients experienced rebleeding or recurrence of the gastric varices after a median follow-up of 1130 d (range 8-2739 d). No major complications occurred after the procedure. However, esophageal varices worsened in 5/17 patients after a mean follow-up of 8.6 mo.

CONCLUSION: Emergency BRTO is an effective and safe treatment for ruptured gastric varices.

Keywords: Emergency balloon-occluded retrograde transvenous obliteration, Gastric varices, Bleeding, Portal hypertension, Ethanolamine oleate

Core tip: As ruptured gastric varices are associated with high rates of recurrent bleeding and mortality, quick treatment is essential. Balloon-occluded retrograde transvenous obliteration (BRTO) is a minimally invasive treatment for gastric varices with a high success rate and a low recurrence rate. Emergency BRTO is an effective and safe treatment, providing temporary hemostasis of ruptured gastric varices can be achieved, allowing the sclerosant to accumulate in the varices.