Gut Liver.  2020 Jan;14(1):117-124. 10.5009/gnl18392.

Evaluation of Treatment Response after Endoscopic Variceal Obturation with Abdominal Computed Tomography

• Lee HA
• Goh HG
• Kim TH
• Lee YS
• Suh SJ
• Jung YK
• Choi HS
• Kim ES
• Kim JH
• An H
• Seo YS
• Yim HJ
• Cho SB
• Jeen YT
• Yeon JE
• Chun HJ
• Byun KS
• Um SH
• Kim CD

• KMID: 2508719
• DOI: http://doi.org/10.5009/gnl18392

Abstract

Backgrounds/Aims
Rebleeding of gastric varices (GVs) after endoscopic variceal obturation (EVO) can be fatal. This study was performed to evaluate the usefulness of computed tomography (CT) for the prediction of rebleeding after EVO GV bleeding.
Methods
Patients who were treated with EVO for GV bleeding and underwent CT before and after EVO were included. CT images of the portal phase showing pretreatment GVs and feeding vessels, and nonenhanced images showing posttreatment cyanoacrylate impaction were reviewed.
Results
Fifty-three patients were included. Their mean age was 60.6±11.6 years, and 40 patients (75.5%) were men. Alcoholic liver disease was the most frequent underlying liver disease (45.3%). Complete impaction of cyanoacrylate in GVs and feeding vessels were achieved in 40 (75.5%) and 24 (45.3%) of patients, respectively. During the follow-up, GV rebleeding occurred in nine patients, and the cumulative incidences of GV rebleeding at 3, 6, and 12 months were 11.8%, 18.9%, and 18.9%, respectively. The GV rebleeding rate did not differ significantly according to the complete cyanoacrylate impaction in the GV, while it differed significantly according to complete cyanoacrylate impaction in the feeding vessels. The cumulative incidences of GV rebleeding at 3, 6, and 12 months were 22.3%, 35.2%, and 35.2%, respectively, in patients with incomplete impaction in feeding vessels, and there was no rebleeding during the follow-up period in patients with complete impaction in the feeding vessels (p=0.002).
Conclusions
Abdominal CT is useful in the evaluation of the treatment response after EVO for GV bleeding. Incomplete cyanoacrylate impaction in feeding vessels is a risk factor for GV rebleeding.

Keyword

Tomography; X-ray computed; Cyanoacrylates; Esophageal and gastric varices; Ethiodized oil