Balloon-assisted percutaneous transhepatic variceal embolization with cyanoacrylate for treatment of isolated gastric varices

doi:10.3877/cma.j.issn.2095-2015.2019.02.002

Abstract

Abstract:

Objective

To evaluate the effectiveness and safety of percutaneous transhepatic variceal embolization(PTVE)with cyanoacrylate assisted with balloon for the treatment of isolated gastric varice(IGV)with gastrorenal shunt(GRS).

Methods

Thirty patients with IGV associated with GRS who underwent balloon-assisted PTVE after shunt balloon occlusion via renal vein in Department of Gastroenterology of Shandong Provincial Hospital Affiliated to Shandong University between March 2010 and June 2015 were retrospectively analyzed.The technical success rate, clinical success rate, complications and follow-up were summarized.

Results

Balloon-assisted PTVE was technically successful in all 30 patients.No serious complications were observed except for one nonsymptomatic pulmonary embolism.During a mean follow-up of 30 months, re-bleeding was observed in 4/30(13.3%)patients, worsening of esophageal varices was observed in 4/30(13.3%)patients, and newly developed or aggravated ascites were observed in 3/30(10%)patients.The 1-, 2-, 3-and 5-year cumulative survival rates were 96.3%, 96.3%, 79.9% and 79.9%, respectively.

Conclusion

Balloon-assisted PTVE with cyanoacrylate is technically feasible, safe and effective for the treatment of IGV associated with GRS, and it is an useful alternative scheme.

Key words: Portal hypertension, Isolated gastric varices, Gastrorenal shunts, Percutaneous transhepatic variceal embolization

Guangchuan Wang, Guangjun Huang, Gonghai Chen, Yongjun Shi, Chunqing Zhang. Balloon-assisted percutaneous transhepatic variceal embolization with cyanoacrylate for treatment of isolated gastric varices[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2019, 09(02): 55-60.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhxhbyyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-2015.2019.02.002

https://zhxhbyyxzz.cma-cmc.com.cn/EN/Y2019/V09/I02/55

Figures/Tables 4

References 20

1	Watanabe K，Kimura K，Matsutani S，et al.Portal hemodynamics in patients with gastric varices.A study in 230 patients with esophageal and/or gastric varices using portal vein catheterization[J]．Gastroenterology，1988，95(2):434-440.
2	Michael PG，Antoniades G，Staicu A，et al.Pulmonary Glue Embolism：An unusual complication following endoscopic sclerotherapy for gastric varices[J]．Sultan Qaboos Univ Med J，2018，18(2):e231-e235.
3	Saad WE.Endovascular management of gastric varices[J]．Clin Liver Dis，2014，18(4):829-851.
4	Imai Y，Nakazawa M，Ando S，et al.Long-term outcome of 154 patients receiving balloon-occluded retrograde transvenous obliteration for gastric fundal varices[J]．J Gastroenterol Hepatol，2016，31(11):1844-1850.
5	Tian X，Shi Y，Hu J，Wang G，et al.Percutaneous transhepatic variceal embolization with cyanoacrylate vs.transjugular intrahepatic portal systematic shunt for esophageal variceal bleeding[J]．Hepatol Int，2013，7(2):636-644.
6	Wang J，Tian XG，Li Y，et al.Comparison of modified percutaneous transhepatic variceal embolization and endoscopic cyanoacrylate injection for gastric variceal rebleeding[J]．World J Gastroenterol.2013.19(5):706-14.
7	Tian X，Wang Q，Zhang C，et al.Modified percutaneous transhepatic variceal embolization with 2-octylcyanoacrylate for bleeding gastric varices：long-term follow-up outcomes[J]．AJR Am J Roentgenol，2011，197(2):502-509.
8	李晶，王广川，胡锦华，等．治疗胃静脉曲张出血的经皮经肝栓塞术和内镜下组织胶注射术比较及预测影响再出血和死亡的风险因素[J]．世界华人消化杂志，2016(3):408-414.
9	Chang CJ，Hou MC，Liao WC，et al.Management of acute gastric varices bleeding[J]．J Chin Med Assoc，2013，76(10):539-546.
10	Garcia-Pagán JC，Barrufet M，Cardenas A，et al.Management of gastric varices[J]．Clin Gastroenterol Hepatol，2014，12(6):919-28.e1;quiz e51-2.
11	Gaba RC，Couture PM，Lakhoo J．Gastroesophageal Variceal Filling and Drainage Pathways：An Angiographic Description of Afferent and Efferent Venous Anatomic Patterns[J]．J Clin Imaging Sci，2015，5:61.
12	Singer AD，Fananapazir G，Maufa F，et al.Pulmonary embolism following 2-octyl-cyanoacrylate/lipiodol injection for obliteration of gastric varices：an imaging perspective[J]．J Radiol Case Rep，2012，6(2):17-22.
13	Park SJ，Chung JW，Kim HC，et al.The prevalence，risk factors，and clinical outcome of balloon rupture in balloon-occluded retrograde transvenous obliteration of gastric varices[J]．J Vasc Interv Radiol，2010，21(4):503-7.
14	Kobayakawa M，Kokubu S，Hirota S，et al.Short-Term Safety and Efficacy of Balloon-Occluded Retrograde Transvenous Obliteration Using Ethanolamine Oleate：Results of a Prospective，Multicenter，Single-Arm Trial[J]．J Vasc Interv Radiol，2017，28(8):1108-1115.e2.
15	Kim DJ，Darcy MD，Mani NB，et al.Modified Balloon-Occluded Retrograde Transvenous Obliteration(BRTO)Techniques for the Treatment of Gastric Varices：Vascular Plug-Assisted Retrograde Transvenous Obliteration(PARTO)/Coil-Assisted Retrograde Transvenous Obliteration(CARTO)/Balloon-Occluded Antegrade Transvenous Obliteration(BATO)[J]．Cardiovasc Intervent Radiol，2018，41(6):835-847.
16	冯华，王广川，胡锦华，等．组织胶经皮经肝食管胃曲张静脉栓塞术治疗肝硬化胃静脉曲张破裂出血远期疗效评价[J/CD]．中华消化病与影像杂志(电子版)，2012，2(6):4-7.
17	张春清，刘福利，梁波，等．经皮经肝组织粘合剂栓塞治疗食管静脉曲张的疗效观察[J]．中华消化内镜杂志，2007，23(4):254-257.
18	Akahoshi T，Hashizume M，Tomikawa M，et al.Long-term results of balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding and risky gastric varices：a 10-year experience[J]．J Gastroenterol Hepatol，2008，23(11):1702-1709.
19	Watanabe M，Shiozawa K，Ikehara T，et al.Short-term effects and early complications of balloon-occluded retrograde transvenous obliteration for gastric varices[J]．ISRN Gastroenterol，2012，2012:919371.
20	Jang SY，Kim GH，Park SY，et al.Clinical outcomes of balloon-occluded retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage in Korean patients with liver cirrhosis：a retrospective multicenter study[J]．Clin Mol Hepatol，2012，18(4):368-374.

特征	患者
年龄(年)	49.5 (26－79)
性别(男/女)	16/14
肝硬化病因	?
HBV/HCV	17/1
酒精/自身免疫性肝病/不明	6/3/3
Child-Pugh分级	?
A/B/C	19/8/3
胃静脉曲张位置	?
IGV1	30
胃静脉曲张的形态	?
F2	11
F3	19
红色征	14
肝性脑病(术前)	2
胃肾分流	30
出血病史	30
随访时间	30个月(2-80)

特征	患者
年龄(年)	49.5 (26－79)
性别(男/女)	16/14
肝硬化病因	?
HBV/HCV	17/1
酒精/自身免疫性肝病/不明	6/3/3
Child-Pugh分级	?
A/B/C	19/8/3
胃静脉曲张位置	?
IGV1	30
胃静脉曲张的形态	?
F2	11
F3	19
红色征	14
肝性脑病(术前)	2
胃肾分流	30
出血病史	30
随访时间	30个月(2-80)

[1]	Jinhua Wu, Guojun Xin, Mingguo Tian, Dazhi Chen. Distribution and incidence of early portal venous system thrombosis after splenectomy combined with pericardial devascularization [J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(03): 168-171.
[2]	Lina Wu, Lin Wei, Zhigui Zeng, Liang Zhang, Enhui He, Yule Tan, Zhijun Zhu, Liying Sun. Pulmonary arterial hypertension targeted drugs combined with liver transplantation for severe portalpulmonary hypertension: a case report [J]. Chinese Journal of Transplantation(Electronic Edition), 2022, 16(06): 376-378.
[3]	Jian Yang, Dazhi Tian, Wentao Jiang, Zhongyang Shen. Clinical study of ligation of large portal shunt vessels with adequate flow during orthotopic liver transplantation [J]. Chinese Journal of Transplantation(Electronic Edition), 2021, 15(02): 65-70.
[4]	Fengshang Zhu, Ling She, Yongnian Ding, Changqing Yang. Application of the five-step questioning method in clinical teaching of cirrhotic portal hypertension [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(02): 116-118.
[5]	Minimally Invasive Intervention Collaboration Group of the Gastroenterology Branch of the Chinese Medical Association. Consensus on hemodynamic classification and clinical management of gastric varices [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2022, 12(06): 325-333.
[6]	Jinming Yan, Chunqing Zhang. Research progress of α₁ adrenergic receptor blockers in the treatment of liver cirrhosis [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2022, 12(04): 232-235.
[7]	Gonghai Chen, Guangchuan Wang, Chunqing Zhang. Idiopathic non-cirrhotic portal hypertension: current progress of diagnosis and treatment [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2021, 11(03): 132-138.
[8]	Aiyuan Xiu, Sining Wang, Qian Ding, Guangchuan Wang, Chunqing Zhang. Experimental study of reducing cirrhotic portal hypertension byα₁ adrenergic receptor blocker [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2021, 11(03): 117-120.
[9]	Yajun Zhang, Jilin Cheng. Identification and treatment of hepatic cirrhosis with portal hypertension and ectopic varices ruptured bleeding [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2021, 11(02): 78-81.
[10]	Qiwei Liang, Yi Huang, Yukuan Tang, Hanwei Chen. Application of balloon-occluded retrograde transvenous obliteration in the treatment of gastric varices [J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2022, 10(04): 436-443.
[11]	Yongyu Zhang, Jianan He, Dashuai Wang, Ni Zhao, Weile Huang, Hui Guo. CT Image fusion-guided portal vein puncture during transjugular intrahepatic portosystemic shunt [J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2022, 10(04): 365-370.
[12]	Jianjun Li, Tong Zhu, Xiaozhen Yang, Shoupeng Sheng, Yonghong Zhang, Jiasheng Zheng. Outcomes of transjugular intrahepatic portosystemic shunt combined with transcatheter arterial chemoembolization sequential thermal ablation in the treatment of portal hypertension with hepatocellular carcinoma [J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2021, 09(03): 252-257,265.
[13]	Xiaobin Zhang, Yingdi Liu, Juan Wang, Guohui Sun, Lisen Zhong, Zhandi He, Enqiang Linghu. Experience for the management of isolated gastric varices [J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2023, 10(03): 167-172.
[14]	Endoscopic Diagnosis and Treatment of Esophagogastric Varices Group, Chinese Society of Digestive Endoscopology, Beijing 100710, China. Chinese expert consensus on endoscopic cyanoacrylate injection for gastrointestinal varices in patients with portal hypertention induced by liver cirrhosis [J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2022, 09(04): 193-206.
[15]	Endoscopic Diagnosis and Treatment of Esophagogastric Varices Group, Chinese Society of Digestive Endoscopology, Beijing 100710, China. Chinese expert consensus on endoscopic injection sclerotherapy for gastroesophageal varices in patients with portal hypertention induced by liver cirrhosis [J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2022, 09(04): 181-192.

Please choose a citation manager

Content to export