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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2022; 6(01): 10-17
DOI: 10.1055/s-0041-1728998
Original Article

Retrograde Transvenous Obliteration of Gastric Varices using Sodium Tetradecyl Sulphate: Technical Considerations and Results from a Single Institution Retrospective Study

Pushpinder S. Khera 
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Pawan K. Garg 
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Sarbesh Tiwari 
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Narendra Bhargava
2   Department of Gastroenterology, Dr S N Medical College, Jodhpur, Rajasthan, India
,
Taruna Yadav
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Binit Sureka 
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Tushar Ghosh 
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Santhosh Babu
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Sunil Dadhich 
2   Department of Gastroenterology, Dr S N Medical College, Jodhpur, Rajasthan, India
,
Surjit Singh 
3   Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Abstract

Introduction Retrograde transvenous obliteration (RTO) with the assistance of a balloon (BRTO) or a vascular plug (PARTO) is an established method for treating gastric varices (GVs) secondary to portal hypertension. Most of the available studies on RTO have used lipiodol along with sclerosing agents like ethanolamine oleate or sodium tetradecyl sulfate (STS). We evaluated the safety and efficacy of RTO for treating GVs using STS as a sclerosant without lipiodol.

Materials and Methods Sixteen patients (nine men, age range 16–74 years) were included in this retrospective study. Twelve patients presented with acute bleeding, two with chronic bleeding, one with large varices without bleeding, and one with refractory hepatic encephalopathy (HE). BRTO was attempted in 14 patients and PARTO in 2 patients. The technical and clinical success and complications of RTO were studied.

Results The RTO procedure was technically successful in 14 (14/16, 87.5%) patients, with 13 (13/14, 93%) obtaining clinical success. One patient died due to the early recurrence of bleeding. Three patients had minor intraprocedural complications.

Conclusion Retrograde gastric variceal obliteration using STS is safe and technically feasible with high technical and clinical success and low complication rate.

Keywords

bleeding gastric varices - retrograde transvenous obliteration - balloon-occluded retrograde transvenous obliteration - plug-assisted retrograde transvenous obliteration - gastrorenal shunt - hepatic encephalopathy - sodium tetradecyl sulfate


Publikationsverlauf

Artikel online veröffentlicht:
18. Mai 2021

© 2021. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 1992; 16 (06) 1343-1349
    CrossrefPubMedGoogle Scholar
  • 2 Trudeau W, Prindiville T. Endoscopic injection sclerosis in bleeding gastric varices. Gastrointest Endosc 1986; 32 (04) 264-268
    CrossrefPubMedGoogle Scholar
  • 3 Mukund A, Chalamarla LK, Singla N, Shasthry SM, Sarin SK. Intractable hepatic encephalopathy in cirrhotic patients: mid-term efficacy of balloon-occluded retrograde portosystemic shunt obliteration. Eur Radiol 2020; 30 (06) 3462-3472
    CrossrefPubMedGoogle Scholar
  • 4 Saad WE, Kitanosono T, Koizumi J, Hirota S. The conventional balloon-occluded retrograde transvenous obliteration procedure: indications, contraindications, and technical applications. Tech Vasc Interv Radiol 2013; 16 (02) 101-151
    CrossrefPubMedGoogle Scholar
  • 5 Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003; 14 (9 Pt 2) S199-S202
    CrossrefPubMedGoogle Scholar
  • 6 Kameda N, Higuchi K, Shiba M. et al Management of gastric fundal varices without gastro-renal shunt in 15 patients. World J Gastroenterol 2008; 14 (03) 448-453
    CrossrefPubMedGoogle Scholar
  • 7 Khera PS, Myungsu L, Joonsung C. Balloon occluded retrograde transvenous obliteration for bleeding gastric varices: Eyes see what the mind knows. Indian J Radiol Imaging 2017; 27 (01) 100-104
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 8 Sarin SK. Long-term follow-up of gastric variceal sclerotherapy: an eleven-year experience. Gastrointest Endosc 1997; 46 (01) 8-14
    CrossrefPubMedGoogle Scholar
  • 9 Roesch W, Rexroth G. Pulmonary, cerebral and coronary emboli during bucrylate injection of bleeding fundic varices. Endoscopy 1998; 30 (08) S89-S90
    PubMedGoogle Scholar
  • 10 Hwang SS, Kim HH, Park SH. et al N-butyl-2-cyanoacrylate pulmonary embolism after endoscopic injection sclerotherapy for gastric variceal bleeding. J Comput Assist Tomogr 2001; 25 (01) 16-22
    CrossrefPubMedGoogle Scholar
  • 11 Binmoeller KF. Endoscopic Ultrasound-Guided Coil and Glue Injection for Gastric Variceal Bleeding. Gastroenterol Hepatol (N Y) 2018; 14 (02) 123-126
    PubMedGoogle Scholar
  • 12 Sanyal AJ, Freedman AM, Luketic VA. et al The natural history of portal hypertension after transjugular intrahepatic portosystemic shunts. Gastroenterology 1997; 112 (03) 889-898
    CrossrefPubMedGoogle Scholar
  • 13 Somberg KA. TIPS: safe, effective, better?. Am J Gastroenterol 1997; 92 (09) 1412-1416
    PubMedGoogle Scholar
  • 14 Riggio O, Nardelli S, Moscucci F, Pasquale C, Ridola L, Merli M. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Clin Liver Dis 2012; 16 (01) 133-146
    CrossrefPubMedGoogle Scholar
  • 15 Saad WE, Simon Jr PO, Rose SC. Balloon-occluded retrograde transvenous obliteration of gastric varices. Cardiovasc Intervent Radiol 2014; 37 (02) 299-315
    CrossrefPubMedGoogle Scholar
  • 16 Olson E, Yune HY, Klatte EC. Transrenal-vein reflux ethanol sclerosis of gastroesophageal varices. Am J Roentgenol 1984; 143 (03) 627-628
    CrossrefPubMedGoogle Scholar
  • 17 Kanagawa H, Mima S, Kouyama H, Gotoh K, Uchida T, Okuda K. Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol 1996; 11 (01) 51-58
    CrossrefPubMedGoogle Scholar
  • 18 Saad WE, Sabri SS. Balloon-occluded retrograde transvenous obliteration (BRTO): technical results and outcomes. Semin Intervent Radiol 2011; 28 (03) 333-338
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 19 Kiyosue H, Mori H, Matsumoto S, Yamada Y, Hori Y, Okino Y. Transcatheter obliteration of gastric varices: Part 2. Strategy and techniques based on hemodynamic features. Radiographics 2003; 23 (04) 921-937
    CrossrefPubMedGoogle Scholar
  • 20 Cameron E, Chen T, Connor DE, Behnia M, Parsi K. Sclerosant foam structure and stability is strongly influenced by liquid air fraction. Eur J Vasc Endovasc Surg 2013; 46 (04) 488-494
    CrossrefPubMedGoogle Scholar
  • 21 Chang IS, Park SW, Kwon SY. et al Efficacy and safety of balloon-occluded retrograde transvenous obliteration with sodium tetradecyl sulfate liquid sclerotherapy. Korean J Radiol 2016; 17 (02) 224-229
    CrossrefPubMedGoogle Scholar
  • 22 Prajapati R, Ranjan P, Gupta A, Yadav AK. balloon-occluded retrograde transvenous obliteration (BRTO): a novel method of control of bleeding from post-glue ulcer over gastric varices. Report of two cases and review of literature. J Clin Exp Hepatol 2016; 6 (04) 326-330
    CrossrefPubMedGoogle Scholar
  • 23 Mukund A, Rajesh S, Arora A, Patidar Y, Jain D, Sarin SK. Efficacy of balloon-occluded retrograde transvenous obliteration of large spontaneous lienorenal shunt in patients with severe recurrent hepatic encephalopathy with foam sclerotherapy: initial experience. J Vasc Interv Radiol 2012; 23 (09) 1200-1206
    CrossrefPubMedGoogle Scholar
  • 24 Choudhary NS, Baijal SS, Saigal S. et al Results of portosystemic shunt embolization in selected patients with cirrhosis and recurrent hepatic encephalopathy. J Clin Exp Hepatol 2017; 7 (04) 300-304
    CrossrefPubMedGoogle Scholar
  • 25 Mukund A, Deogaonkar G, Rajesh S, Shasthry SM, Sarin SK. Safety and efficacy of sodium tetradecyl sulfate and lipiodol foam in balloon-occluded retrograde transvenous obliteration (BRTO) for large porto-systemic shunts. Cardiovasc Intervent Radiol 2017; 40 (07) 1010-1016
    CrossrefPubMedGoogle Scholar