Premium
Variant treatment for gastric varices with polidocanol foam using balloon‐occluded retrograde transvenous obliteration: A pilot study
Author(s) -
Clements Warren,
Cavanagh Karda,
Ali Faizal,
Kavnoudias Helen,
Kemp William,
Roberts Stuart,
Lyon Stuart
Publication year - 2012
Publication title -
journal of medical imaging and radiation oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.31
H-Index - 43
eISSN - 1754-9485
pISSN - 1754-9477
DOI - 10.1111/j.1754-9485.2012.02453.x
Subject(s) - medicine , polidocanol , transjugular intrahepatic portosystemic shunt , gastric varices , varices , sclerotherapy , portal hypertension , balloon , cirrhosis , radiology , surgery , varix , endoscopy , catheter
Treatment of gastric variceal rupture remains difficult with current options including transjugular intrahepatic portosystemic shunt and endoscopic therapies having significant side effects or reduced efficacy. We report five cases of gastric varices that were successfully treated with balloon‐occluded retrograde transvenous obliteration of varices ( BRTO ) using Polidocanol foam as an alternative sclerosant to ethanolamine oleate. Methods Patients were recruited with cirrhotic liver disease, a history of upper gastrointestinal bleeding, and large gastric fundal varices confirmed on gastroscopy and CT venogram. BRTO was performed as a same‐day procedure using a balloon catheter inserted via a gastro‐renal shunt with Polidocanol foam injected and a balloon inflated for 2 h. Follow‐up was with repeat CT portovenogram, gastroscopy at 6 weeks post‐procedure, and in a gastroenterology liver clinic at 1‐ to 3‐month intervals. Results Between J anuary and D ecember 2009, five patients safely underwent BRTO therapy of gastric varices without complication. At 6 weeks following the procedure, upper gastrointestinal endoscopy showed complete resolution of varices in 5 out of 5 patients, while CT portovenography showed resolution of varices in 4 out of 5 patients, with results in the last patient inconclusive. Clinical follow‐up at 1, 3 and 6 months indicated no further episodes of bleeding. Conclusions Our study further supports the use of foam sclerosants including Polidocanol in BRTO , showing it is a safe and effective minimally‐invasive procedure to treat gastric fundal varices in the short term.