Ierardi AM, Carnevale A, Tosetti G, D'Amico M, Giganti M, Mura VL, Bonelli C, Renzulli M, Lampertico P, Primignani M, Carrafiello G. Combined approach for embolization of otherwise unmanageable gastric varices.
Ann Gastroenterol 2021;
34:510-515. [PMID:
34276189 PMCID:
PMC8276367 DOI:
10.20524/aog.2021.0616]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/28/2021] [Indexed: 11/24/2022] Open
Abstract
Background
This study aimed to determine the feasibility, safety and effectiveness of
combined percutaneous transhepatic obliteration (PTO) and balloon-occluded
retrograde transvenous obliteration (BRTO) therapy for the treatment of
patients with high-risk bleeding gastric varices.
Methods
Ten patients were retrospectively reviewed. All the patients presented
gastric varices, according to the Sarin classification, at high risk of
bleeding, and not otherwise manageable. Patients with portal vein thrombosis
were excluded. All patients were treated with a combination of PTO and BRTO.
In all cases the gastric varices were embolized with glue, combined with
coils or not, with an occlusion balloon inflated into the shunt. In 7 cases,
embolization was immediate; in the remaining 3 the balloon remained inflated
for 4 h and in 2 of them embolization of the shunt was required. Technical
success was defined as complete obliteration of the gastric varices observed
during a contrast-enhanced computed tomography study and endoscopy within 1
month following treatment. Clinical success was defined as absence of
bleeding of gastric varices during the follow-up period. Major and minor
complications during the follow up were recorded.
Results
Twelve sessions of combined PTO and BRTO procedures were performed in 10
patients; in 2 patients a new combined treatment was required during the
follow up. Technical and clinical success was 100%. Neither major nor
minor procedure-related complications were observed.
Conclusion
Combined PTO and BRTO therapy is safe and effective for the treatment of
gastric varices that cannot be managed otherwise.
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