Gastric varices and hepatic encephalopathy: Treatment with vascular plug and gelatin sponge-Assisted retrograde transvenous obliteration-A primary report

Dong Il Gwon, Gi Young Ko, Hyun Ki Yoon, Kyu Bo Sung, Jin Hyoung Kim, Ji Hoon Shin, Heung Kyu Ko, Ho Young Song

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

Abstract

Purpose: To evaluate technical safety, clinical safety, and effectiveness of vascular plug-Assisted retrograde transvenous obliteration (RTO) for treatment of gastric varices (GV) and hepatic encephalopathy (HE). Materials and Methods: This retrospective study was approved by the institutional review board; written informed consent was waived. From April 2009 to December 2011, 20 patients (13, GV; seven, HE) who had undergone vascular plug-Assisted RTO were retrospectively evaluated. After retrograde transvenous placement of a vascular plug in the left adrenal vein or gastrorenal shunt, subsequent gelatin-sponge embolization of both gastrorenal shunt and GV was performed. Follow-up computed tomography (CT) and upper gastrointestinal tract endoscopy were performed; clinical and laboratory data were collected to evaluate primary (technical success, complications, clinical success) and secondary (change of liver function by using the Child-Pugh score, worsening of esophageal varices) end points. Laboratory data before and after vascular plug-Assisted RTO were compared (paired-sample t test). Results: Placement of the vascular plug and subsequent gelatinsponge embolization were technically successful in all 20 patients, with no procedure-related complications. Follow-up CT within 1 week after vascular plug-Assisted RTO showed complete thrombosis of GV and gastrorenal shunts in all patients. Clinical symptoms of HE completely resolved in all seven patients with HE; mean serum NH3 level of 127.4 mmol/L 6 58 (standard deviation) before vascular plug-Assisted RTO decreased significantly to 28.1 mmol/L 6 9.8 within 1 week after vascular plug-Assisted RTO (P = .002). Eighteen patients who underwent follow-up longer than 2 months showed complete obliteration of GV and gastrorenal shunts at CT and endoscopy. There were no cases of variceal bleeding or HE during mean follow-up of 422 days. Improvement in Child-Pugh score was observed in 12 of 18 (67%) patients 1 month after vascular plug-Assisted RTO. Worsening of esophageal varices was observed in four (22%) patients at mean follow-up of 9.4 months. Conclusion: Vascular plug-Assisted RTO is technically simple and safe and seems to be clinically effective for treatment of GV and HE.

Original languageEnglish (US)
Pages (from-to)281-287
Number of pages7
JournalRadiology
Volume268
Issue number1
DOIs
StatePublished - Jul 1 2013
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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