Korean J Radiol.  2016 Apr;17(2):224-229. 10.3348/kjr.2016.17.2.224.

Efficacy and Safety of Balloon-Occluded Retrograde Transvenous Obliteration with Sodium Tetradecyl Sulfate Liquid Sclerotherapy

Affiliations
  • 1Department of Radiology, Digestive Disease Center, Konkuk University School of Medicine, Seoul 05030, Korea. 20040017@kuh.ac.kr
  • 2Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul 05030, Korea.

Abstract


OBJECTIVE
To evaluate the efficacy and safety of balloon-occluded retrograde transvenous obliteration (BRTO) with sodium tetradecyl sulfate (STS) liquid sclerotherapy of gastric varices.
MATERIALS AND METHODS
Between February 2012 and August 2014, STS liquid sclerotherapy was performed in 17 consecutive patients (male:female = 8:9; mean age 58.6 years, range 44-86 years) with gastric varices. Retrograde venography was performed after occlusion of the gastrorenal shunt using a balloon catheter and embolization of collateral draining veins using coils or gelfoam pledgets, to evaluate the anatomy of the gastric varices. We prepared 2% liquid STS by mixing 3% STS and contrast media in a ratio of 2:1. A 2% STS solution was injected into the gastric varices until minimal filling of the afferent portal vein branch was observed (mean 19.9 mL, range 6-33 mL). Patients were followed up using computed tomography (CT) or endoscopy.
RESULTS
Technical success was achieved in 16 of 17 patients (94.1%). The procedure failed in one patient because the shunt could not be occluded due to the large diameter of gastrorenal shunt. Complete obliteration of gastric varices was observed in 15 of 16 patients (93.8%) with follow-up CT or endoscopy. There was no rebleeding after the procedure. There was no procedure-related mortality.
CONCLUSION
BRTO using STS liquid can be a safe and useful treatment option in patients with gastric varices.

Keyword

Sodium tetradecyl sulfate; Portal hypertension; Balloon-occluded retrograde transvenous obliteration; Gastric varices

MeSH Terms

Adult
Aged
Aged, 80 and over
Balloon Occlusion
Contrast Media/*chemistry
Demography
Embolization, Therapeutic
Endoscopy, Digestive System
Esophageal and Gastric Varices/*therapy
Female
Follow-Up Studies
Humans
Male
Middle Aged
Portal Vein/radiography
Sclerotherapy
Sodium Tetradecyl Sulfate/*chemistry
Tomography, X-Ray Computed
Contrast Media
Sodium Tetradecyl Sulfate

Figure

  • Fig. 1 59-year-old woman (patient ID No. 5) presented with hematemesis and melena from gastric varices. A. Fluoroscopic image shows liquid sclerotherapy with 16-mL mixture of 3% STS and nonionic contrast media (final STS concentration was 2%). To note that no air bubbles are present in gastric varices. B. Contrast-enhanced CT scan obtained before BRTO shows multiple dilated gastric varices (arrows). C. Contrast-enhanced CT scan obtained 98 days after BRTO shows complete resolution of gastric varices (arrows). BRTO = balloon-occluded retrograde transvenous obliteration, CT = computed tomography, STS = sodium tetradecyl sulfate


Cited by  1 articles

Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Varices: The Role of Intra-Procedural Cone-Beam Computed Tomography
Dong Il Gwon, Gi-Young Ko, Young Baek Kwon, Hyun-Ki Yoon, Kyu-Bo Sung
Korean J Radiol. 2018;19(2):223-229.    doi: 10.3348/kjr.2018.19.2.223.


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