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Eight years of experience with transjugular retrograde obliteration for gastric varices with gastrorenal shunts.
Surgery. 2001 Apr; 129(4):414-20.S

Abstract

BACKGROUND AND OBJECTIVES

There is no standard treatment for gastric varices. Transjugular retrograde obliteration (TJO) is one way of obliterating gastric varices with gastrorenal shunts, in which blood flow is abundant. Our aim was to examine our experience with TJO during an 8-year period and to determine the long-term effects of this treatment.

METHODS

We performed TJO procedures in 52 patients to obliterate gastric varices. All the patients had liver cirrhosis. Sixteen had hepatocellular carcinoma (HCC) without vascular invasion. We inserted an angiographic catheter with an occlusive balloon through the right internal jugular vein into the gastrorenal shunt or the gastric varices. After controlling the other blood-draining routes with a microcoil or absolute ethanol, or both, we injected 5% ethanolamine oleate with iopamidol into the gastric varices under fluoroscopy.

RESULTS

The gastric varices were successfully obliterated by TJO in all cases. The complications were all minor and transient. The mortality rate for TJO was 0%. There was no recurrence and no bleeding of gastric varices at all after TJO. Patient survival differed depending on the presence or absence of HCC (P <.05). The development of HCC in the cirrhotic liver was the most common cause of late death. Gastrointestinal bleeding was not a cause of death. The occurrence rate of esophageal varices after TJO was high, but these varices could be treated easily by endoscopic injection sclerotherapy before they bled.

CONCLUSIONS

Portal blood flow through the gastrorenal shunt is diverted to the porto-azygos venous system after the gastrorenal shunt is obliterated by TJO. TJO is a safe option that we recommend for treating gastric varices with gastrorenal shunts, provided that the TJO is followed by endoscopic injection sclerotherapy.

Authors+Show Affiliations

Department of Surgery and the Department of Internal Medicine, Kuniyoshi Hospital, 1-3-4 Kamimachi, Kochi, 780-0091 Japan.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11283531

Citation

Chikamori, F, et al. "Eight Years of Experience With Transjugular Retrograde Obliteration for Gastric Varices With Gastrorenal Shunts." Surgery, vol. 129, no. 4, 2001, pp. 414-20.
Chikamori F, Kuniyoshi N, Shibuya S, et al. Eight years of experience with transjugular retrograde obliteration for gastric varices with gastrorenal shunts. Surgery. 2001;129(4):414-20.
Chikamori, F., Kuniyoshi, N., Shibuya, S., & Takase, Y. (2001). Eight years of experience with transjugular retrograde obliteration for gastric varices with gastrorenal shunts. Surgery, 129(4), 414-20.
Chikamori F, et al. Eight Years of Experience With Transjugular Retrograde Obliteration for Gastric Varices With Gastrorenal Shunts. Surgery. 2001;129(4):414-20. PubMed PMID: 11283531.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Eight years of experience with transjugular retrograde obliteration for gastric varices with gastrorenal shunts. AU - Chikamori,F, AU - Kuniyoshi,N, AU - Shibuya,S, AU - Takase,Y, PY - 2001/4/3/pubmed PY - 2001/5/22/medline PY - 2001/4/3/entrez SP - 414 EP - 20 JF - Surgery JO - Surgery VL - 129 IS - 4 N2 - BACKGROUND AND OBJECTIVES: There is no standard treatment for gastric varices. Transjugular retrograde obliteration (TJO) is one way of obliterating gastric varices with gastrorenal shunts, in which blood flow is abundant. Our aim was to examine our experience with TJO during an 8-year period and to determine the long-term effects of this treatment. METHODS: We performed TJO procedures in 52 patients to obliterate gastric varices. All the patients had liver cirrhosis. Sixteen had hepatocellular carcinoma (HCC) without vascular invasion. We inserted an angiographic catheter with an occlusive balloon through the right internal jugular vein into the gastrorenal shunt or the gastric varices. After controlling the other blood-draining routes with a microcoil or absolute ethanol, or both, we injected 5% ethanolamine oleate with iopamidol into the gastric varices under fluoroscopy. RESULTS: The gastric varices were successfully obliterated by TJO in all cases. The complications were all minor and transient. The mortality rate for TJO was 0%. There was no recurrence and no bleeding of gastric varices at all after TJO. Patient survival differed depending on the presence or absence of HCC (P <.05). The development of HCC in the cirrhotic liver was the most common cause of late death. Gastrointestinal bleeding was not a cause of death. The occurrence rate of esophageal varices after TJO was high, but these varices could be treated easily by endoscopic injection sclerotherapy before they bled. CONCLUSIONS: Portal blood flow through the gastrorenal shunt is diverted to the porto-azygos venous system after the gastrorenal shunt is obliterated by TJO. TJO is a safe option that we recommend for treating gastric varices with gastrorenal shunts, provided that the TJO is followed by endoscopic injection sclerotherapy. SN - 0039-6060 UR - https://www.unboundmedicine.com/medline/citation/11283531/Eight_years_of_experience_with_transjugular_retrograde_obliteration_for_gastric_varices_with_gastrorenal_shunts_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0039-6060(01)21563-3 DB - PRIME DP - Unbound Medicine ER -