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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 8, 2016; 8(19): 790-795
Published online Jul 8, 2016. doi: 10.4254/wjh.v8.i19.790
Published online Jul 8, 2016. doi: 10.4254/wjh.v8.i19.790
Could there be light at the end of the tunnel? Mesocaval shunting for refractory esophageal varices in patients with contraindications to transjugular intrahepatic portosystemic shunt
Jessica Davis, Department of Internal Medicine, George Washington University, Washington, DC 20037, United States
Albert K Chun, Department of Radiology, George Washington University, Washington, DC 20037, United States
Marie L Borum, Division of Gastroenterology and Liver Diseases, George Washington University, Washington, DC 20037, United States
Author contributions: Davis J wrote the manuscript; Chun AK provided fluoroscopic images; Borum ML provided endoscopic images; Chun AK and Borum ML revised the manuscript.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Marie L Borum, MD, EdD, MPH, Director of the Division of Gastroenterology and Liver Disease, George Washington University, 2150 Pennsylvania Avenue, NW Suite 3-405, Washington, DC 20037, United States. mborum@mfa.gwu.edu
Telephone: +1-202-7412160 Fax: +1-202-7412169
Received: March 25, 2016
Peer-review started: March 25, 2016
First decision: May 17, 2016
Revised: May 19, 2016
Accepted: June 14, 2016
Article in press: June 16, 2016
Published online: July 8, 2016
Peer-review started: March 25, 2016
First decision: May 17, 2016
Revised: May 19, 2016
Accepted: June 14, 2016
Article in press: June 16, 2016
Published online: July 8, 2016
Core Tip
Core tip: Cirrhotic patients who have recurrent variceal hemorrhage despite medical and endoscopic therapy have limited options if they are not transjugular intrahepatic portosystemic shunting candidates. One promising new method to decrease portal pressures while avoiding surgical shunt placement is mesocaval shunt placement with fluoroscopic guidance. In this paper we review the technique, candidate selection, potential pitfalls and benefits of mesocaval shunt placement.