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      Balloon-occluded retrograde transvenous obliteration with lauromacrogol sclerosant foam for gastric varices

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          Abstract

          Objectives

          To evaluate the safety and efficacy of balloon-occluded retrograde transvenous obliteration (BRTO) using lauromacrogol sclerosant foam for gastric varices (GVs) with gastrorenal venous shunts.

          Methods

          Data of GV patients treated with BRTO using lauromacrogol sclerosant foam in 2016–2020 were retrospectively analyzed along with procedural success rate, complications, and follow-up efficacy.

          Results

          A total of 31 patients were treated with BRTO. The sclerosant foam was prepared by mixing iodinated oil, lauromacrogol, and air at a 1:2:3 ratio. The BRTO procedure was successfully completed in 93.5% of patients. One patient was allergic to the lauromacrogol injection. A mild postoperative fever occurred in three patients. One patient experienced grand mal seizures after the procedure. There was no significant difference in the median Child-Turcotte-Pugh scores before versus after BRTO. Complete GV resolution was observed in 93.1% of patients. One patient underwent endoscopic treatment for the development of high-risk esophageal varices. Another patient underwent transjugular intrahepatic portosystemic shunt placement for the aggravation of ascites.

          Conclusions

          Lauromacrogol sclerosant foam is safe and effective in patients undergoing BRTO for GV.

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          Most cited references22

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          Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension.

          Roberto de Franchis (2015)
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            Retrograde transvenous obliteration of gastric varices.

            S Hirota, M Tomita, M Sako … (1999)
            To evaluate the clinical efficacy, techniques, and complications associated with balloon-occluded retrograde transvenous obliteration of gastric varices. Between December 1994 and November 1997, balloon-occluded retrograde transvenous obliteration was performed on 20 patients with gastric varices in danger of rupture and with gastrorenal shunts; three patients also had hepatic encephalopathy. The sclerosant was injected into the gastric varices during balloon occlusion. The degree of progression of the gastric varices and of collateral veins was classified into five grades, with grade 1 being least progression and grade 5 most progression; collateral veins that had developed were treated with embolization. Follow-up consisted of fiberoptic endoscopy and computed tomography. Technical success was achieved in all patients. Occlusion of collateral veins was essential for the occlusion of gastric varices with a grade greater than grade 2. The clinical symptoms of hepatic encephalopathy in the three patients improved remarkably. Follow-up endoscopy 3 months after the procedure revealed the disappearance of gastric varices in 15 patients and reduced variceal size in five. During the follow-up period, 19 patients had no recurrence of gastric varices; three patients had aggravation of the esophageal varices. Balloon-occluded retrograde transvenous obliteration is a feasible alternative to a transjugular intrahepatic portosystemic shunt for patients with large gastrorenal shunts or hepatic encephalopathy (or both).
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              Long-term follow-up of gastric variceal sclerotherapy: an eleven-year experience.

              Shiv Sarin (1997)
              Bleeding from gastric varices is often a serious medical emergency. The role of endoscopy in the management of gastric variceal bleeding is still controversial. The types of gastric varices and their respective management strategies have not been identified. Gastric varices were observed in 209 patients with portal hypertension. Seventy-one patients (with cirrhosis 33, noncirrhotic 38) underwent gastric variceal sclerotherapy, 53 of these (75%) for gastric variceal bleeding. By use of a previously described classification, gastric varices were divided into gastroesophageal varices, type 1 (GOV1) and type 2 (GOV2), and isolated gastric varices, type 1 (IGV 1). Gastric variceal sclerotherapy was done every week using a combination technique of paravariceal and intravariceal injections with absolute alcohol. Emergency gastric variceal sclerotherapy arrested acute bleeding in 12 (66.7%) of 18 patients. Variceal obliteration was achieved in 43 of the 60 (71.6%) patients who underwent repeated elective sclerotherapy. Variceal obliteration was higher in patients with GOV1 (94.4%) than in those with GOV2 (70.4%) and IGV1 (41%). Rebleeding after elective gastric variceal sclerotherapy was seen in 5.5%, 19%, and 53%, respectively, in the three types of gastric varices. Gastric variceal recurrence was not seen during a mean follow-up of 24.2 +/- 22.9 months. Seventeen (24%) patients died, nearly equally from rebleeding and liver failure. (1) Sclerotherapy can effectively arrest acute gastric variceal bleeding and achieve gastric variceal obliteration, (2) it is more effective in patients with gastroesophageal varices, and (3) alternative therapies need to be evaluated for patients with IGV1.
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                Author and article information

                Contributors
                Zhongmin Wang
                Xiaoyi Ding
                Journal
                Journal ID (nlm-ta): J Interv Med
                Journal ID (iso-abbrev): J Interv Med
                Title: Journal of Interventional Medicine
                Publisher: Shanghai Journal of Interventional Radiology Press
                ISSN (Print): 2096-3602
                ISSN (Electronic): 2590-0293
                Publication date PMC-release: 16 June 2022
                Publication date Collection: August 2022
                Publication date (Electronic): 16 June 2022
                Volume: 5
                Issue: 3
                Pages: 138-142
                Affiliations
                [a ]Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
                [b ]Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
                [c ]Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, 15213, Pennsylvania, USA
                [d ]Shanghai Clinical Research Center Member for Interventional Medicine, China
                Author notes
                [∗∗ ]Corresponding author. Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. wzm0722@ 123456hotmail.com
                [∗ ]Corresponding author. Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. dxy10456@ 123456rjh.com.cn
                [1]

                Zhiyuan Wu, Wei Wu and Cheng Tao contributed equally to this work.

                Article
                Publisher Item ID: S2096-3602(22)00036-9
                DOI: 10.1016/j.jimed.2022.06.002
                PMC ID: 9617148
                PubMed ID: 36317150
                SO-VID: 2e6a108d-b5de-40b2-bb41-470e11c69f55
                Copyright © © 2022 Shanghai Journal of Interventional Radiology Press. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 30 March 2022
                Date revision received : 23 May 2022
                Date accepted : 6 June 2022
                Categories
                Subject: Article

                Keywords: gastric varices,gastrorenal shunt,balloon-occluded retrograde transvenous obliteration,sclerotherapy
                Data availability:
                Keywords: gastric varices, gastrorenal shunt, balloon-occluded retrograde transvenous obliteration, sclerotherapy

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