J Korean Soc Radiol.  2011 Oct;65(4):357-363. 10.3348/jksr.2011.65.4.357.

Comparison of Coil Embolization and Slcerotherapy of Collateral Veins during Balloon Occluded Retrograde Transvenous Obliteration: Its Long Term Effect for Gastric Varix Treatment

• An EJ
• Kim YH
• Kim SH

• KMID: 2002936
• DOI: http://doi.org/10.3348/jksr.2011.65.4.357

Abstract

PURPOSE
We compared the long term effect gastric varix treatment between coil embolization and sclerotherapy of collateral veins during balloon occluded retrograde transvenous obliteration (BRTO).
MATERIALS AND METHODS
Between February 2004 and November 2008 48 patients with gastric varix bleeding successfully treated with BRTO 23 underwent embolization of collateral veins during BRTO were enrolled in this study. In patients, collateral veins were embolized with the use of microcoil (group 1). Agent (5% ethanolamine oleate + lipiodol) was used in the remaining 7 patients (Group 2). Recurrence and rebleeding of gastric varix were evaluated by endoscopy or CT.
RESULTS
Gastric varix recurred in 4 patients (17.4%) and rebleeding occurred in 2 (8.7%). Recurrence (57.1%, p = 0.001) and rebleeding (28.6%, p = 0.029) of gastric occurred in group 2. CT finding within 6 months in partial or complete thrombosis without lipiodol uptake in gastric varix, gastric varix recurred on follow up CT.
CONCLUSION
Coil embolization of collateral veins during BRTO may promote complete obliteration of gastric varix, provide lower recurrence and rebleeding rates of gastric sclerosing agent on long term follow-up.

MeSH Terms

Endoscopy
Esophageal and Gastric Varices
Ethanolamine
Ethiodized Oil
Follow-Up Studies
Hemorrhage
Humans
Oleic Acid
Oleic Acids
Recurrence
Sclerotherapy
Thrombosis
Veins
Ethanolamine
Ethiodized Oil
Oleic Acid
Oleic Acids

Figure

• 

  Fig. 1 A 71-year-old male presented with hematemesis. A. CT scan shows gastric varices. B. Balloon-occluded left renal venogram reveals partial contrast filling in the gastric varices with small-sized collateral veins (Hirota grade 3, Kiyosue type B1). C. Balloon-occluded left adrenal venogram obtained after embolization of collateral veins with 5% ethanolamine oleate-lipiodol mixture reveals full visualization of gastric fundal varices. D. CT scan obtained 11 days after successful BRTO shows thrombosis of gastric varix without lipiodol uptake (arrow). E. 19 months follow up CT scan shows recurrence of gastric varix (arrow). Note.-BRTO = balloon occluded retrograde transvenous obliteration

• 

  Fig. 2 A 42-year-old male presented with hematemesis. A. CT scan shows large gastric fundal varices. B. BRTO was successfully performed after coil embolization of collateral vein. C. Twenty months follow-up CT scan reveals complete obliteration of gastric varix with lipiodol uptake (arrow). Note.-BRTO = balloon occluded retrograde transvenous obliteration

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