Comparison of Coil Embolization and Slcerotherapy of Collateral Veins during Balloon Occluded Retrograde Transvenous Obliteration: Its Long Term Effect for Gastric Varix Treatment

Eun Jung An; Young Hwan Kim; See Hyung Kim

doi:10.3348/jksr.2011.65.4.357

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An, Kim, and Kim: Comparison of Coil Embolization and Slcerotherapy of Collateral Veins during Balloon Occluded Retrograde Transvenous Obliteration: Its Long Term Effect for Gastric Varix Treatment

Interventional Radiology

Original Article

Journal of the Korean Society of Radiology 2011; 65(4): 357-363.

Published online: 31 October 2011

DOI: https://doi.org/10.3348/jksr.2011.65.4.357

Comparison of Coil Embolization and Slcerotherapy of Collateral Veins during Balloon Occluded Retrograde Transvenous Obliteration: Its Long Term Effect for Gastric Varix Treatment

Eun Jung An, MD, Young Hwan Kim, MD, See Hyung Kim, MD

Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea.

Corresponding author: Young Hwan Kim, MD. Department of Radiology, Keimyung University College of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Korea. Tel. 82-53-250-7770, Fax. 82-53-250-7766, yhkim68@dsmc.or.kr

Received 22 June 2011 Accepted 15 August 2011

Abstract

Purpose

We compared the long term effect gastric varix treatment between coil embolization and sclerotherapy of collateral veins during balloon occluded retrograde transvenous obliteration (BRTO).

Materials and Methods

Between February 2004 and November 2008 48 patients with gastric varix bleeding successfully treated with BRTO 23 underwent embolization of collateral veins during BRTO were enrolled in this study. In patients, collateral veins were embolized with the use of microcoil (group 1). Agent (5% ethanolamine oleate + lipiodol) was used in the remaining 7 patients (Group 2). Recurrence and rebleeding of gastric varix were evaluated by endoscopy or CT.

Results

Gastric varix recurred in 4 patients (17.4%) and rebleeding occurred in 2 (8.7%). Recurrence (57.1%, p = 0.001) and rebleeding (28.6%, p = 0.029) of gastric occurred in group 2. CT finding within 6 months in partial or complete thrombosis without lipiodol uptake in gastric varix, gastric varix recurred on follow up CT.

Conclusion

Coil embolization of collateral veins during BRTO may promote complete obliteration of gastric varix, provide lower recurrence and rebleeding rates of gastric sclerosing agent on long term follow-up.

Keywords: Gastric Varix, Balloon Occluded Retrograde Transvenous Obliteration, Embolization, Coil, Sclerotherapy

Figures and Tables

Fig. 1

A 71-year-old male presented with hematemesis.

A. CT scan shows gastric varices.

B. Balloon-occluded left renal venogram reveals partial contrast filling in the gastric varices with small-sized collateral veins (Hirota grade 3, Kiyosue type B1).

C. Balloon-occluded left adrenal venogram obtained after embolization of collateral veins with 5% ethanolamine oleate-lipiodol mixture reveals full visualization of gastric fundal varices.

D. CT scan obtained 11 days after successful BRTO shows thrombosis of gastric varix without lipiodol uptake (arrow).

E. 19 months follow up CT scan shows recurrence of gastric varix (arrow).

Note.-BRTO = balloon occluded retrograde transvenous obliteration

Fig. 2

A 42-year-old male presented with hematemesis.

A. CT scan shows large gastric fundal varices.

B. BRTO was successfully performed after coil embolization of collateral vein.

C. Twenty months follow-up CT scan reveals complete obliteration of gastric varix with lipiodol uptake (arrow).

Note.-BRTO = balloon occluded retrograde transvenous obliteration

Table 1

Hirota Grade and Kiyosue Classification of Patients

Note.-Group 1 = Patient with coil embolization of collateral vein, Group 2 = Patient with sclerotherapy of collateral vein

Table 2

Characteristic of Patients with Recurred Gastric Varix after BRTO

Note.-BRTO = balloon occluded retrograde transvenous obliteration, EVL = endoscopic vascular ligation

Table 3

Fisher's Exact Test for Intergroup Comparison between Group 1 and Group 2

Note.-Group 1 = Patient with coil embolization of collateral vein, Group 2 = Patient with sclerotherapy of collateral vein.

EV = esophageal varices, GV = gastric varices, UGI = upper gastrointestinal

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