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balloon-occluded retrograde transvenous obliteration with lauromacrogol sclerosant foam for gastric varices

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Journal of Interventional Medicine 2022年第3期5卷 138-142页

作者： Zhiyang Wu Wei Wu Cheng Tao Qin Liu Wenchang Li Qinbing Wang Wei Huang Junwei Gu Xiaoyan Fei Zhongmin Wang Xiaoyi Ding Department of Interventional Radiology Rujin HospitalShanghai Jiao Tong University School of MedicineShanghai200025China Department of Gastroenterology Rujin HospitalShanghai Jiao Tong Universiy School of MedicineShanghai200025China Department of Radiology University of Pttsburgh School of MedicinePittsburgh15213PennsylvaniaUSA Shanghai Clinical Research Center Member for Interventional Medicine China

Objectives:To evaluate the safety and efficacy of balloon-occluded retrograde transvenous obliteration(BRTO)using lauromacrogol sclerosant foam for gastric varices(GVs)with gastrorenal venous ***:Data of GV patients treated with BRTO using lauromacrogol sclerosant foam in 2016–2020 were retrospectively analyzed along with procedural success rate,complications,and follow-up ***:A total of 31 patients were treated with *** sclerosant foam was prepared by mixing iodinated oil,lauromacrogol,and air at a 1:2:3 *** BRTO procedure was successfully completed in 93.5%of *** patient was allergic to the lauromacrogol injection.A mild postoperative fever occurred in three *** patient experienced grand mal seizures after the *** was no significant difference in the median Child-Turcotte-Pugh scores before versus after *** GV resolution was observed in 93.1%of *** patient underwent endoscopic treatment for the development of high-risk esophageal *** patient underwent transjugular intrahepatic portosystemic shunt placement for the aggravation of ***:Lauromacrogol sclerosant foam is safe and effective in patients undergoing BRTO for GV.

关键词： Gastric varices Gastrorenal shunt balloon-occluded retrograde transvenous obliteration Sclerotherapy

Transhepatic catheter-directed thrombolysis for portal vein thrombosis after partial splenic embolization in combination with balloon-occluded retrograde transvenous obliteration of splenorenal shunt

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World Journal of Gastroenterology 2006年第31期12卷 5071-5074页

作者： Motoki Nakai Morio Sato Shinya Sahara Nobuyuki Kawai Masashi Kimura Yoshimasa Maeda Yumiko Ibata Katsuhiko Higashi Department of RadiologyWakayama Medical University 811-1KimiideraWakayama ShiWakayama 641-8510Japan the First Department of Internal MedicineHidaka General Hospital 116-2 SonoGobo ShiWakayama 644-8655Japan

A 66-year-old woman underwent partial splenic embolization （PSE） for hypersplenisrn with idiopathic portal hypertension （IPH）. One week later, contrast-enhanced CT revealed extensive portal vein thrombosis （PVT） and dilated portosystemic shunts. The PVT was not dissolved by the intravenous administration of urokinase. The right portal vein was canulated via the percutaneous transhepatic route under ultrasonic guidance and a 4 Fr. straight catheter was advanced into the portal vein through the thrombus. Transhepatic catheter-directed thrombolysis was performed to dissolve the PVT and a splenorenal shunt was concurrently occluded to increase portal blood flow, using balloon-occluded retrograde transvenous obliteration （BRTO） technique. Subsequent contrast-enhanced CT showed good patency of the portal vein and thrombosed splenorenal shunt. Transhepatic catheter-directed thrombolysis combined with BRTO is feasible and effective for PVT with portosystemic shunts.

关键词： Portal vein thrombosis Idiopathic portal hypertension Partial splenic embolization Portosystemic shunts Transhepatic catheter-directed thrombolysis balloon-occluded retrograde transvenous obliteration

Treatment of portosystemic shunt-borne hepatic encephalopathy in a 97-year-old woman using balloon-occluded retrograde transvenous obliteration:A case report

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World Journal of Clinical Cases 2023年第4期11卷 945-951页

作者： Akihiro Nishi Tsuneaki Kenzaka Misa Sogi Shuichiro Nakaminato Takahiro Suzuki General Medicine Awa Regional Medical CenterTateyama 2940014ChibaJapan Division of Community Medicine and Career Development Kobe University Graduate School of MedicineKobe 6500017HyogoJapan Department of Radiology Kameda Medical CenterKamogawa 2968602ChibaJapan

BACKGROUND Hyperammonemia and hepatic encephalopathy are common in patients with portosystemic *** shunt occlusion has been standard treatment,although recently the less invasive balloon-occluded retrograde transvenous obliteration(B-RTO)has gained increasing *** far,there have been no reports on the treatment of portosystemic shunts with B-RTO in patients aged over 90 *** this study,we present a case of hepatic encephalopathy caused by shunting of the left common iliac and inferior mesenteric veins,successfully treated with *** SUMMARY A 97-year-old woman with no history of liver disease was admitted to our hospital because of disturbance of *** had no jaundice,spider angioma,palmar erythema,hepatosplenomegaly,or *** blood tests showed hyperammonemia,and abdominal contrast-enhanced computed tomography revealed a portosystemic shunt running between the left common iliac vein and the inferior mesenteric *** was diagnosed with hepatic encephalopathy secondary to a portosystemic *** patient did not improve with conservative treatment:Lactulose,rifaximin,and a low-protein diet.B-RTO was performed,which resulted in shunt closure and improvement in hyperammonemia and disturbance of ***,there was no abdominal pain or elevated levels of liver enzymes due to *** patient was discharged without further consciousness *** Portosystemic shunt-borne hepatic encephalopathy must be considered in the differential diagnosis for consciousness disturbance,including abnormal behavior and speech.

关键词： Hepatic encephalopathy Hyperammonemia Portosystemic shunt balloon-occluded retrograde transvenous obliteration Elderly Case report

Ectopic Ascending Colonic Variceal Bleeding Treated with balloon-occluded retrograde transvenous obliteration in a Decompensated Liver Cirrhosis Patient—A Hepatology Perspective

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Case Reports in Clinical Medicine 2020年第7期9卷 191-200页

作者： Gim Hin Ho Suresh Babu Chern Hao Chong Constantinos P. Anastassiades Division of Gastroenterology Department of Medicine Khoo Teck Puat Hospital Singapore Department of Diagnostic Radiology Interventional Radiology Khoo Teck Puat Hospital Singapore Gut Care Digestive Liver Endoscopy Associates Singapore Division of Gastroenterology and Hepatology Department of Medicine National University Hospital Singapore

Ectopic colonic varices development from liver cirrhosis and portal hypertension is uncommon. They are part of the spectrum of portal hypertensive colopathy. Colonic variceal bleeding remains a rare cause of lower gastrointestinal tract (GI) bleeding. Due to the paucity of cases, there are no well-established conventional treatments for bleeding colonic varices. Different treatments have been reported. Here, we report a case of a 55-year-old gentleman, with a history of alcoholic liver cirrhosis, presenting with severe lower GI bleeding and symptomatic anaemia. An esophagogastroduodenoscopy revealed large esophageal varices with high-risk bleeding stigmata requiring endoscopic variceal ligation. A cross-sectional computed tomography scan showed colonic portosystemic shunts. In light of this and that the severe lower GI bleeding seemed out of proportion to the esophageal varices seen on upper endoscopy, an urgent unprepped colonoscopy was performed which revealed possible bleeding diverticula disease which required endoscopic mechanical hemoclip therapy. However, despite this, patient had recurrence of lower GI bleeding prompting a second colonoscopy. This relook colonoscopy showed ectopic ascending colon varices with high-risk bleeding stigmata. High-dose intravenous vasoactive agent somatostatin (500 mcg/hour) and subsequently terlipressin (2 mg every 4 hours) were used. The patient subsequently underwent successful balloon-occluded retrograde transvenous obliteration (B-RTO) and sclerotherapy. The non-selective beta-blocker (NSBB) carvedilol was started and bridged together with the vasoactive agent until stabilisation of portal hypertension. This difficult case illustrates the dynamic nature of portal hypertensive bleeding. It also highlights the presence of confounding non-variceal pathology complicating diagnosis of portal hypertensive colonic variceal bleeding, and that ectopic ascending colonic variceal bleeding can be treated successfully with B-RTO and scle

关键词： Ectopic Varices Colonic Varices Portal Hypertension balloon-occluded retrograde transvenous obliteration Sclerotherapy Liver Cirrhosis

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

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World Journal of Gastroenterology 2008年第3期14卷 448-453页

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 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

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.

关键词： Gastric fundal varices Gastro-renal shunt balloon-occluded retrograde transvenous obliteration