Balloon-occluded retrograde transvenous obliteration for gastric varices with gastrorenal or gastrocaval collaterals

Abstract

OBJECTIVE. The purpose of this study was to evaluate the efficacy of balloon-occluded retrograde transvenous obliteration for gastric varices with gastrorenal or gastrocaval collaterals. SUBJECTS AND METHODS. Thirty patients who had gastric varices with gastrorenal or gastrocaval collaterals underwent balloon-occluded retrograde transvenous obliteration. A 5-French balloon catheter was inserted in the gastrorenal collateral, gastrocaval collateral, or both, and a 5% solution of ethanolamine oleate iopamidole that contained equal amounts of ethanolamine oleate and iopamidole 300 was injected into the gastric varices. One day, 1 week, and 1 month after balloon-occluded retrograde transvenous obliteration, hepatic and renal function tests (total bilirubin, transaminase, blood ammonia, serum creatinine, and blood urea nitrogen) were done. To evaluate therapeutic efficacy, we observed the site with endoscopy every 2 weeks and obtained enhanced CT scans every month. The observation time ranged from 10 to 30 months. RESULTS. After balloon-occluded retrograde transvenous obliteration, gastric varices disappeared completely in all 30 cases in 4-16 weeks (mean, 10 weeks). Recurrence of gastric varices was observed in three cases (10%), which were treated with repeated balloon- occluded retrograde transvenous obliteration. Esophageal varices were aggravated in three patients (10%), who underwent successful endoscopic injection sclerotherapy. Complications of balloon-occluded retrograde transvenous obliteration were fever and hemoglobinuria, which disappeared in about 5 days. We observed no significant hepatic and renal functional damage. CONCLUSION. Balloon-occluded retrograde transvenous obliteration offers good control of gastric varices with gastrorenal or gastrocaval collaterals, even if hepatic function is poor.