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

作     者：Natsuhiko Kameda Kazuhide Higuchi Masatsugu Shiba Kaori Kadouchi Hirohisa Machida Hirotoshi Okazaki Tetsuya Tanigawa Toshio Watanabe Kazunari Tominaga Yasuhiro Fujiwara Kenji Nakamura Tetsuo Arakawa 

作者机构：Department of Gastroenterology Graduate School of Medicine Osaka City University Osaka 569-8686 Japan Second Department of Internal Medicine Osaka Medical College Osaka 569-8686 Japan Department of Radiology Graduate School of Medicine Osaka City University Osaka 569-8686 Japan 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2008年第14卷第3期

页      面：448-453页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Gastric fundal varices Gastro-renal shunt Balloon-occluded retrograde transvenous obliteration 

摘      要：AIM:To examine the portal hemodynamics of gastric fundal varices (GV) without gastro-renal shunt (GRS), and to retrospectively investigate the effects of various kinds of treatment on eradication. METHODS: Ninety-four liver cirrhosis patients at high- risk of GV were treated in our hospital and enrolled in this study. We retrospectively examined their characteristics, liver function, and portal hemodynamics of GV. We performed balloon-occluded retrograde transvenous obliteration (BRTO) at first. If it was not technically possible to perform BRTO, endoscopic injection sclerotherapy using α-cyanoacrylate glue (CA) or percutaneous transhepatic obliteration (PTO) was performed. RESULTS: Among the 94 patients, a GRS was present in 79 (84.0%), and absent in the remaining 15 (16.0%). The subphrenic vein was connected to the inferior vena cava as the drainage vein in 13 (86.7%) out of the 15 cases without GRS. We performed BRTO in 6 patients, CA in 4 patients and PTO in 5 patients. The eradication rate was 100% for each procedure, but the rate of early recurrence within 6 mo was 16.7% for BRTO, 50.0% for CA and 40.0% for PTO, respectively. CONCLUSION: 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.