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Balloon‐occluded retrograde transvenous obliteration using a microballoon catheter for intractable gastric fundal varices
Author(s) -
Imai Yukinori,
Nakazawa Manabu,
Ando Satsuki,
Sugawara Kayoko,
Hamaoka Kazuhiro,
Oka Masashi,
Mochida Satoshi
Publication year - 2014
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12351
Subject(s) - medicine , gastric varices , catheter , surgery , venography , varices , balloon , radiology , balloon catheter , shunt (medical) , thrombosis , gastroenterology , cirrhosis
Background and Aim Balloon‐occluded retrograde transvenous obliteration ( B ‐ RTO ) is recognized as the standard therapy for patients with gastric fundal varices in J apan; however, the procedure is difficult when drainage veins other than the gastrorenal shunt developed. The efficacy and safety of B ‐ RTO using a microballoon catheter for such patients were evaluated. Methods The subjects were 99 patients with gastric fundal varices who fulfilled the criteria for receiving endoscopic and/or interventional therapies. Among these, 95 patients underwent B ‐ RTO . Of the 95 patients, 14 were treated with the use of microballoon catheters, including nine in whom the left inferior phrenic vein was found as a secondary drainage vein in addition to the gastrorenal shunt, and five in whom a gastrorenal shunt was absent. The B ‐ RTO procedure performed using a microballoon catheter inserted through the left inferior phrenic vein in 13 patients, and through the pericardiophrenic vein in one patient. Results The B ‐ RTO procedure using microballoon catheters was successful in 13 of the 14 patients (93%), while in the remaining one patient, multiple drainage veins were visualized on venography. Complete obliteration of the varices was achieved in all the 13 patients by injection of 5% ethanolamine oleate iopamidol at a median volume of 25 mL (range, 11 to 40 mL) through the catheters. None of the patients showed injuries of the drainage veins or any systemic complications. Conclusions B ‐ RTO using a microballoon catheter is useful for the treatment of gastric fundal varices in which drainage veins other than the gastrorenal shunt developed.