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Combination treatment of transjugular retrograde obliteration and endoscopic embolization for portosystemic encephalopathy with esophageal varices.
Hepatogastroenterology. 2004 Sep-Oct; 51(59):1379-81.H

Abstract

The treatment of chronic portosystemic encephalopathy with esophageal varices has not yet been established. We were able to control a case of chronic portosystemic encephalopathy with esophageal varices using a combination treatment of transjugular retrograde obliteration and endoscopic embolization. A 57-year-old man came to our hospital in a confused, apathetic and tremulous state. The grade of encephalopathy was II. The plasma ammonia level was abnormally elevated to 119 microg/dL, and the ICGR15 was 59%. Endoscopic examination revealed nodular esophageal varices with cherry-red spots. There were no gastric varices. Ultrasonography and CT revealed liver cirrhosis with a splenorenal shunt. We first applied endoscopic embolization for the esophageal varices before transjugular retrograde obliteration. We injected 5% ethanolamine oleate with iopamidol retrogradely into the esophageal varices and their associated blood routes under fluoroscopy and obliterated the palisade vein, the cardiac venous plexus and left gastric vein. Transjugular retrograde obliteration was performed 14 days after endoscopic embolization. Retrograde shunt venography visualized the splenorenal shunt and communicating route to the retroperitoneal vein. There was no communicating route to the azygos vein. After obliteration of the communicating route to the retroperitoneal vein with absolute ethanol, 5% ethanolamine oleate with iopamidol was injected into the splenorenal shunt as far as the root of the posterior gastric vein. After transjugular retrograde obliteration, the encephalopathy improved to grade 0 even without the administration of lactulose and branched-chain amino acid. The plasma ammonia level and ICGR15 were reduced to 62 microg/dL and 26%. We conclude that combination treatment of transjugular retrograde obliteration and endoscopic embolization is a rational, effective and safe treatment for chronic portosystemic encephalopathy complicated with esophageal varices.

Authors+Show Affiliations

Department of Surgery, Kuniyoshi Hospital, Tsukuba Soai Hospital, Japan. chikamor@i-kochi.or.jpNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

15362757

Citation

Chikamori, Fumio, et al. "Combination Treatment of Transjugular Retrograde Obliteration and Endoscopic Embolization for Portosystemic Encephalopathy With Esophageal Varices." Hepato-gastroenterology, vol. 51, no. 59, 2004, pp. 1379-81.
Chikamori F, Kuniyoshi N, Shibuya S, et al. Combination treatment of transjugular retrograde obliteration and endoscopic embolization for portosystemic encephalopathy with esophageal varices. Hepatogastroenterology. 2004;51(59):1379-81.
Chikamori, F., Kuniyoshi, N., Shibuya, S., & Takase, Y. (2004). Combination treatment of transjugular retrograde obliteration and endoscopic embolization for portosystemic encephalopathy with esophageal varices. Hepato-gastroenterology, 51(59), 1379-81.
Chikamori F, et al. Combination Treatment of Transjugular Retrograde Obliteration and Endoscopic Embolization for Portosystemic Encephalopathy With Esophageal Varices. Hepatogastroenterology. 2004 Sep-Oct;51(59):1379-81. PubMed PMID: 15362757.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combination treatment of transjugular retrograde obliteration and endoscopic embolization for portosystemic encephalopathy with esophageal varices. AU - Chikamori,Fumio, AU - Kuniyoshi,Nobutoshi, AU - Shibuya,Susumu, AU - Takase,Yasuhiro, PY - 2004/9/15/pubmed PY - 2004/10/13/medline PY - 2004/9/15/entrez SP - 1379 EP - 81 JF - Hepato-gastroenterology JO - Hepatogastroenterology VL - 51 IS - 59 N2 - The treatment of chronic portosystemic encephalopathy with esophageal varices has not yet been established. We were able to control a case of chronic portosystemic encephalopathy with esophageal varices using a combination treatment of transjugular retrograde obliteration and endoscopic embolization. A 57-year-old man came to our hospital in a confused, apathetic and tremulous state. The grade of encephalopathy was II. The plasma ammonia level was abnormally elevated to 119 microg/dL, and the ICGR15 was 59%. Endoscopic examination revealed nodular esophageal varices with cherry-red spots. There were no gastric varices. Ultrasonography and CT revealed liver cirrhosis with a splenorenal shunt. We first applied endoscopic embolization for the esophageal varices before transjugular retrograde obliteration. We injected 5% ethanolamine oleate with iopamidol retrogradely into the esophageal varices and their associated blood routes under fluoroscopy and obliterated the palisade vein, the cardiac venous plexus and left gastric vein. Transjugular retrograde obliteration was performed 14 days after endoscopic embolization. Retrograde shunt venography visualized the splenorenal shunt and communicating route to the retroperitoneal vein. There was no communicating route to the azygos vein. After obliteration of the communicating route to the retroperitoneal vein with absolute ethanol, 5% ethanolamine oleate with iopamidol was injected into the splenorenal shunt as far as the root of the posterior gastric vein. After transjugular retrograde obliteration, the encephalopathy improved to grade 0 even without the administration of lactulose and branched-chain amino acid. The plasma ammonia level and ICGR15 were reduced to 62 microg/dL and 26%. We conclude that combination treatment of transjugular retrograde obliteration and endoscopic embolization is a rational, effective and safe treatment for chronic portosystemic encephalopathy complicated with esophageal varices. SN - 0172-6390 UR - https://www.unboundmedicine.com/medline/citation/15362757/Combination_treatment_of_transjugular_retrograde_obliteration_and_endoscopic_embolization_for_portosystemic_encephalopathy_with_esophageal_varices_ L2 - http://www.diseaseinfosearch.org/result/2658 DB - PRIME DP - Unbound Medicine ER -