Journal List > J Korean Soc Radiol > v.64(2) > 1086890

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Kim, Kim, An, Kim, and Choi: CT Findings after BRTO in Patients with Gastric Varix Bleeding: Can We Predict Varix Recurrence
Interventional Radiology
Original Article

Journal of the Korean Society of Radiology 2011; 64(2): 131-137.

Published online: 28 February 2011

DOI: https://doi.org/10.3348/jksr.2011.64.2.131

CT Findings after BRTO in Patients with Gastric Varix Bleeding: Can We Predict Varix Recurrence

Joo Hwan Kim, M.D., Young Hwan Kim, M.D., Eun Jung An, M.D., See Hyung Kim, M.D., Jin Soo Choi, M.D.

1Department of Radiology, Dongsan Medical Center, Keimyung University, College of Medicine, Daegu, Korea.

Address reprint requests to: Young Hwan Kim, M.D., Department of Radiology, Keimyung University, 216 Dalsung-ro, Jung-gu, Daegu 700-752, Korea. Tel. 82-53-250-7770, Fax. 82-53-250-7766, yhkim68@dsmc.co.kr

Received 11 June 2010       Accepted 6 October 2010

Copyright © 2011 The Korean Society of Radiology

Abstract

Purpose

We wanted to retrospectively evaluate the CT findings after balloon occluded retrograde transvenous obliteration (BRTO) to determine whether the CT findings can predict varix recurrence.

Materials and Methods

Of the 48 patients with gastric varix that was bleeding successfully treated with BRTO between February 2004 and November 2008, 35 of them who underwent follow-up endoscopy and CT were enrolled in this study. The morphologic changes of the gastric varix, including gastrorenal shunt and an afferent vein, were evaluated with the use of CT.

Results

Gastric varix recurred in 4 patients and rebleeding occurred in 2. In 22 of 25 patients who underwent CT within 6 months, complete thrombosis of the gastric varix filled with lipiodol was noted, and the gastric varix disappeared without recurrence in all the patients during the long term follow up period. In the other 3 patients who only had thrombosis without lipiodol in the gastric varix, the gastric varices recurred (p=0.0001).

Conclusion

The existence of lipiodol, as seen on CT within 6 months after BRTO, was useful to predict complete obliteration of gastric varices without recurrence during the long term follow up period.

Keywords: Esophageal and Gastric Varices, Balloon Occlusion, Computed Tomography (CT), Gastrointestinal Hemorrhage

Figures and Tables

Fig. 1

A 67-year-old male presented with hematemesis.

A. CT scan shows gastric varix (arrow) and blood clot in the stomach.
B, C. CT scan obtained 2 days after BRTO shows complete thrombosis filled with lipiodol in the gastric varix, posterior gastric vein (arrow) and gastrorenal shunt (arrow head). Ascites is developed after BRTO.
D. Seventeen months follow-up CT scan reveals complete obliteration of gastric varix and improvement of ascites.
jksr-64-131-g001
Fig. 2

A 71-year-old male presented with hematemesis.

A. CT scan shows gastric varix (arrow).
B, C. CT scan obtained 11 days after BRTO shows thrombosis of gastric varix without lipiodol uptake (arrow), the posterior gastric
D. Seventeen months follow up CT scan shows recurrence of gastric varix (arrow). and he complained of gastric varix rebleeding two months later.
jksr-64-131-g002
Table 1

CT findings After BRTO

jksr-64-131-i001

Note.─ CO = Complete Obliteration of Varix , Pat = Patent of Varix, CL = Compact Lipiodol Uptake , PL = Partial Lipiodol Uptake, NL = No Lipiodol Uptake, T = Thrombus , PT = Partial thrombus

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