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KMID : 0980720100290020090
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Keimyung Medical Journal
2010 Volume.29 No. 2 p.90 ~ p.97
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UGI Bleeding After Balloon-occluded Retrograde Transvenous Obliteration
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Kim Hyun-Ah
Hwang Jae-Seok
Chung Woo-Jin
Lee Yeong-Seok
Hong Yoon-Suk
Lee Jung-Min
Lee Hyun-Woong
Kim Tae-Yul
Lee Sun-Young
Choi Jae-Hyuk
Kim Young-Hwan
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Abstract
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Background /Aim: Balloon-occluded retrograde transvenous obliteration (BRTO), for the treatment of bleeding gastric varices, has been performed. It is likely that they have high eradication rate and low complication rate of gastric varix. The aim of our study was to evaluate the rebleeding tendency after BRTO in patients with gastric variceal bleeding.
Methods: Forty one patients with gastric varices who were treated with BRTO from March 2004 to February 2008, were analyzed retrospectively.
Results: The mean follow up duration was 14.5 months. The cause of cirrhosis was hepatitis B in 14 patients, hepatitis C in four patients, alcoholic liver disease in 22 patients, other disease in one patient. Child-Pugh classification grade A, B, C were 20, 19, 2 respectively. The patients who had coexisting hepatocellular carcinoma were 15 patients. Complete obliteration was achieved in 35 patients (85.4%). Rebleeding occurred in 5 of 35 (14.3%) patients after BRTO.
The cause of rebleeding was gastric varices (n=1), gastric ulcer (n=3), duodenal varices (n=1). Nine of 35 (25.7%) patients died after the procedure. The median survival period was 37.2±4.6 months. Among 35 patients with complete obliteration, 13 patients underwent a CT scan within 3 months and follow-up CT or endoscopy 6 months later. In 11 patients, gastrorenal shunt was filled with ethanolamine oleate (EO) mixed lipiodol on a CT scan within 3 months and gastric varices disappeared on follow-up CT after 6 months later. However, two patients were not observed those findings in gastrorenal shunt, gastric varices were recurred (p=0.013).
Conclusion: Our study showed that rebleeding from gastric varices was rare findings after successful BRTO.
The presence of EO mixed lipiodol in gastrorenal shunt on a CT scan within 3 months after complete BRTO was useful to predict reappearance of gastric varices.
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KEYWORD
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Balloon-occluded retrograde transvenous obliteration, Gastric varices, Liver
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