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W E Saad, J F B Chick, R N Srinivasa, N Saad, S Kim, A Fischman, G Frey, A Al-Osaimi, S Caldwell
PURPOSE: To assess the 2-year effectiveness and safety of balloon-occluded retrograde transvenous obliteration (BRTO) for gastric varices (GVs) in liver transplant recipients. MATERIALS AND METHODS: Eleven liver transplant recipients underwent consecutive BRTO for GVs at four institutions. Patients included eight (73%) men and three (27%) women with mean age of 56 years±12 (SD) (range: 26-67 years). Underlying cause of liver transplantation was hepatitis C virus (HCV)-related cirrhosis in five (45%), alcohol- and HCV-related cirrhosis in three (27%), primary biliary cirrhosis in two (18%), and alcoholic cirrhosis in one (9%)...
April 13, 2017: Diagnostic and Interventional Imaging
Seung Kwon Kim, Kristen A Lee, Steven Sauk, Kevin Korenblat
OBJECTIVE: Although a transjugular intrahepatic portosystemic shunt (TIPS) is commonly placed to manage isolated gastric varices, balloon-occluded retrograde transvenous obliteration (BRTO) has also been used. We compare the long-term outcomes from these procedures based on our institutional experience. MATERIALS AND METHODS: We conducted a retrospective review of patients with isolated gastric varices who underwent either TIPS with a covered stent or BRTO between January 2000 and July 2013...
March 2017: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
Amar Mukund, Ganesh Deogaonkar, S Rajesh, Saggerre Muralikrishna Shasthry, Shiv Kumar Sarin
OBJECTIVE: To evaluate the safety and efficacy sodium tetradecyl sulfate and lipiodol foam (STS foam) in BRTO for large (caliber ≥15 mm) porto-systemic shunt and gastric fundal varices. MATERIALS AND METHODS: It is a retrospective record-based study of patients who underwent BRTO using STS foam at the Institute of Liver and Biliary Sciences, New Delhi, for gastric variceal bleed or refractory hepatic encephalopathy (HE) who had large porto-systemic shunt (diameter ≥15 mm) with or without associated gastric varices...
February 8, 2017: Cardiovascular and Interventional Radiology
Junhwan Kim, Danbi Lee, Kyunghwan Oh, Mingee Lee, Seol So, Dong Hoon Yang, Chan Wook Kim, Dong Il Gwon, Young Hwa Chung
Jejunal variceal bleeding is less common compared with esophagogastric varices in patients with portal hypertension. However, jejunal variceal bleeding can be fatal without treatment. Treatments include surgery, transjugular intrahepatic porto-systemic shunt (TIPS), endoscopic sclerotherapy, percutaneous coil embolization, and balloon-occluded retrograde transvenous obliteration (BRTO). Percutaneous coil embolization can be considered as an alternative treatment option for those where endoscopic sclerotherapy, surgery, TIPS or BRTO are not possible...
January 25, 2017: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
Ritesh Prajapati, Piyush Ranjan, Arun Gupta, Ajit K Yadav
Bleeding gastric varices (GV) are managed by cyanoacrylate glue injection with transjugular intrahepatic portosystemic shunt (TIPSS) as modality for treatment failure. Ulcer can form at the site of glue injection over GV and it can cause bleeding. Treatment approach for such bleed is not well described. Balloon-occluded retrograde transvenous obliteration (BRTO), TIPSS, and devascularization remain the treatment options in this scenario. BRTO is an endovascular procedure where a balloon catheter is inserted into a draining vein of GV, and the sclerosant can be injected into the varices through the catheter during balloon occlusion...
December 2016: Journal of Clinical and Experimental Hepatology
Catherine E Hansing, Joseph P Marquardt, Daniel M Sutton, John D York
Arteriovenous malformations (AVMs) are a high-flow form of a vascular malformation, which can be found anywhere in the body. While historically treated surgically, a multidisciplinary approach utilizing multiple specialties and treatment modalities is now commonly employed. In order to effectively treat an AVM, the nidus must be targeted and eradicated, which can be done via multiple approaches. We present the case of a 43-year-old male with a gastric wall AVM, which was initially incompletely treated using a percutaneous transarterial approach...
February 2017: Cardiovascular and Interventional Radiology
Qiong Wu, Hua Jiang, Enqiang Linghu, Lanjing Zhang, Weifeng Wang, Jie Zhang, Zhandi He, Juan Wang, Yunsheng Yang, Guohui Sun, Gang Sun
AIMS: We evaluated the feasibility, efficacy and safety of a novel technique of balloon-occluded retrograde transvenous obliteration (BRTO) assisted endoscopic Histoacryl (N-buthyl-2-cyanoacrylate) injection. MATERIAL AND METHODS: A total with 11 patients were enrolled and analyzed in this single center, open-label, prospective study. Patients with high-risk gastric varices (defined as fundal varices, large GV (>5 mm), presence of a red spot, and Child-Pugh score C) and concurrent gastrorenal shunt underwent endoscopic Histoacryl injection while the gastrorenal shunt was temporarily occluded with an occlusion balloon...
December 2016: Minimally Invasive Therapy & Allied Technologies: MITAT
Akira Yamamoto, Norifumi Nishida, Hiroyasu Morikawa, Atsushi Jogo, Ken Kageyama, Etsuji Sohgawa, Shinichi Hamamoto, Toru Takeshita, Yukimasa Sakai, Toshiyuki Matsuoka, Norifumi Kawada, Yukio Miki
PURPOSE: To investigate predictive factors and cutoff value of transient elastography (TE) measurements for assessing improvement in liver function after balloon-occluded retrograde transvenous obliteration (BRTO) for gastric varices (GV). MATERIALS AND METHODS: Retrospective analysis was performed of 50 consecutive patients followed for > 3 months after BRTO, who had undergone TE before BRTO between January 2011 and February 2015. The correlation between change in liver function (total bilirubin, albumin, and prothrombin time) and baseline liver function values and liver stiffness measurement (LSM) by TE was evaluated by Pearson correlation test...
August 2016: Journal of Vascular and Interventional Radiology: JVIR
Nobuyuki Toshikuni, Yoshitaka Takuma, Mikihiro Tsutsumi
Bleeding from gastroesophageal varices (GEV) is a serious event in cirrhotic patients and can cause death. According to the explosion theory, progressive portal hypertension is the primary mechanism underlying variceal bleeding. There are two approaches for treating GEV: primary prophylaxis to manage bleeding or emergency treatment for bleeding followed by secondary prophylaxis. Treatment methods can be classified into two categories: 1) Those used to decrease portal pressure, such as medication (i.e., nonselective β-blockers), radiological intervention [transjugular intrahepatic portosystemic shunt (TIPS)] or a surgical approach (i...
May 2016: Annals of Hepatology
Thomas R McCarty, Mena Bakhit, Tarun Rustagi
Isolated gastric varices are far less prevalent in Western countries where the rate of splenic thrombosis is much lower. However, in Asian countries the entity is more common and therefore a more robust treatment approach has been developed. Balloon-occlusive retrograde transvenous obliteration (BRTO) was first described in 1984 and then revived in 1996. The procedure, while uncommon in the U.S. and not recognized by the AASLD practice guidelines, allows for direct exclusion from the portosystemic system. Here we describe the case of a patient with alcoholic cirrhosis decompensated by bleeding gastric varices treated with BRTO...
March 2016: Journal of Gastrointestinal and Liver Diseases: JGLD
Il Soo Chang, Sang Woo Park, So Young Kwon, Won Hyeok Choe, Young Koog Cheon, Chan Sup Shim, Tae Yoon Lee, Jeong Han Kim
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...
March 2016: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
Young Hwan Kim, Young Hwan Kim, Chan Sun Kim, Ung Rae Kang, See Hyung Kim, Joo Hwan Kim
PURPOSE: To compare the clinical outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) using ethanolamine oleate (EO), BRTO using sodium tetradecyl sulfate (STS) foam, and vascular plug-assisted retrograde transvenous obliteration (PARTO). MATERIALS AND METHODS: From April 2004 to February 2015, ninety-five patients underwent retrograde transvenous obliteration for gastric varices were analyzed retrospectively. BRTO with EO was performed in 49 patients, BRTO with STS foam in 25, and PARTO in 21...
June 2016: Cardiovascular and Interventional Radiology
Yun-Bing Wang, Jian-Ying Zhang, Jian-Ping Gong, Fan Zhang, Yong Zhao
BACKGROUND AND AIM: The aim of this study was to compare the feasibility and safety of both balloon-occluded retrograde transvenous obliteration (BRTO) versus transjugular intrahepatic portosystemic shunt (TIPS) for treatment of gastric varices due to portal hypertension through the method of meta-analysis. METHODS: PubMed, Embase, and Cochrane Library were searched for both randomized controlled trials and cohort studies concerning BRTO compared with TIPS in the treatment of gastric varices from their inception to April 26, 2015...
April 2016: Journal of Gastroenterology and Hepatology
Zhassulan Baimakhanov, Akihiko Soyama, Mitsuhisa Takatsuki, Yusuke Inoue, Hajime Matsushima, Masaaki Hidaka, Amane Kitasato, Tomohiko Adachi, Tamotsu Kuroki, Ichiro Sakomoto, Susumu Eguchi
Balloon-occluded retrograde transvenous obliteration (BRTO) has become a common and effective procedure for treating hepatic encephalopathy due to a portosystemic shunt related to cirrhosis of the liver. However, this method of treatment has rarely been reported in patients after liver transplantation. Here, we report the case of a 52-year-old patient who underwent living donor liver transplantation (LDLT) due to hepatitis C virus-infected hepatocellular carcinoma that was complicated with portal vein thrombosis and a large portosystemic shunt between the superior mesenteric vein (SMV) and inferior vena cava (IVC)...
August 2014: Clinical Journal of Gastroenterology
Alexander Copelan, Monzer Chehab, Purushottam Dixit, Mitchell S Cappell
UNLABELLED: BACKGROUND/RATIONALE OF STUDY: Analyze safety and efficacy of angiographic-occlusion-with-sclerotherapy/embolotherapy-without-transjugular-intrahepatic-portosystemic-shunt (TIPS) for duodenal varices. Although TIPS is considered the best intermediate-to-long term therapy after failed endoscopic therapy for bleeding varices, the options are not well-defined when TIPS is relatively contraindicated, with scant data on alternative therapies due to relative rarity of duodenal varices...
May 2015: Annals of Hepatology
Vivek A Saraswat, Abhai Verma
Bleeding from gastric varices (GV) continues to pose a challenge to the endoscopist and no consensus has been reached on the best way for treating these patients. Gastric variceal obturation (GVO) with the tissue adhesive, N-2-butyl-cyanoacrylate (NBC), is considered the treatment of first-choice for this condition in most parts of the world. The liquid monomer polymerizes into a solid cast, obturating the vessel within 10-20 s of coming in contact with ionic solutions such as blood. Gastric variceal obturation achieves hemostasis in over 90% of patients with active bleeding, eradicates GV in over 80% of these patients, and re-bleeding occurs in 3-30%...
March 2012: Journal of Clinical and Experimental Hepatology
Tadahiro Goto, Ippei Matsumoto, Makoto Shinzeki, Hirochika Toyama, Sadaki Asari, Azusa Ueta, Jun Ishida, Yoshihide Nanno, Shinichi So, Hisoka Kinoshita, Taku Matsumoto, Kaori Kuramitsu, Motofumi Tanaka, Atsushi Takebe, Masahiro Kido, Tetsuo Ajiki, Takumi Fukumoto, Yonson Ku
Here, we report a case of Hassab's operation for left-sided portal hypertension after pancreatoduodenectomy. A 69-year old man underwent pancreatoduodenectomy for pancreatic cancer in 2006 in which the splenic vein was ligated near the portal vein and then divided. The patient suffered repeated episodes of anemia between 2010 and 2013. However, we could not identify the bleeding site at that time. In 2011, local recurrence was detected. Disease progression occurred despite chemotherapy treatment, which was then discontinued...
November 2014: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Vinaya Gaduputi, Harish Patel, Sailaja Sakam, Srivani Neshangi, Rafeeq Ahmed, Michael Lombino, Sridhar Chilimuri
INTRODUCTION: Portal hypertension results from increased resistance to portal blood flow and has the potential complications of variceal bleeding and ascites. The splenoportal veins increase in caliber with worsening portal hypertension, and partially decompress by opening a shunt with systemic circulation, ie, a varix. In the event of portosystemic shunting, there is a differential decompression across the portal vein and splenic vein (portal vein > splenic vein), with a resultant decrease in the ratio of portal vein diameter to that of splenic vein...
2015: Clinical and Experimental Gastroenterology
Wael E Saad, Allison Lippert, Sandra Schwaner, Abdullah Al-Osaimi, Saher Sabri, Nael Saad
OBJECTIVES: Endoscopic experience in the management of duodenal varices (DVs) is limited and challenging given the anatomic constraints and limited experience. The endovascular management of DVs is not yet established and the controversy of whether to manage them by decompression with a transjugular intrahepatic portosystemic shunt (TIPS) or by transvenous obliteration is unresolved. In the literature, the 6-12 month rebleeding rate of DVs after TIPS is 21-37% and after transvenous obliteration is 13%...
2014: Journal of Clinical Imaging Science
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