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New transjugular retrograde obliteration without the use of ethanolamine oleate for gastric varices.
Surg Laparosc Endosc Percutan Tech. 2015 Feb; 25(1):e27-e32.SL

Abstract

OBJECTIVES

The purpose of this study was to investigate the short-term effects of new transjugular retrograde obliteration (TJO) without the use of ethanolamine oleate for gastric varices with a gastrorenal shunt.

PATIENTS AND METHODS

Ten patients with gastric varices and a gastrorenal shunt were included in this study. Through the right internal jugular vein, a 5- or 6-Fr angiographic catheter with an occlusive balloon was inserted into the gastrorenal shunt. The balloon was inflated to occlude the gastrorenal shunt blood flow. Microcoils were used to obliterate the main blood drainage routes of gastric vein, such as inferior phrenic and and/or retroperitoneal veins. Continuous injection of 0.5 to 1.0 mL of absolute ethanol and 2 to 15 mL of 50% glucose solution into the gastrorenal shunt was carried out under fluoroscopy. This procedure was repeated at 5-minute intervals until gastric varices were clearly visualized. 5% ethanolamine oleate with iopamidol (5% EOI) was not used as a sclerosant.

RESULTS

TJO without 5% EOI technically succeeded in all cases. Total volumes of absolute ethanol and 50% glucose solution for the variceal obliteration were 6±4 and 56±46 mL, respectively. To produce thrombi in the gastric varices, the catheter had to be retained for 24 hours in 7 patients and for 48 hours in 3. The volumes of absolute ethanol and 50% glucose solution were 4±2 and 37±20 in the former 7 patients and 11±4 and 100±64 mL in the latter 3 patients, respectively. Only minor complications were observed, which were as follows: fever >38°C in 6 patients, epigastric pain in 8 patients, and temporary hypertension in 2 patients. Computed tomography scan and endoscopic examination 3 months after TJO revealed complete eradication of gastric varices in all cases.

CONCLUSIONS

We conclude that new TJO without the use of 5% EOI is an effective and safe method for gastric varices.

Authors+Show Affiliations

Departments of Surgery Internal Medicine, Kuniyoshi Hospital, Kochi, Japan.No affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Clinical Study
Journal Article

Language

eng

PubMed ID

24743676

Citation

Chikamori, Fumio, et al. "New Transjugular Retrograde Obliteration Without the Use of Ethanolamine Oleate for Gastric Varices." Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, vol. 25, no. 1, 2015, pp. e27-e32.
Chikamori F, Okamoto H, Kuniyoshi N. New transjugular retrograde obliteration without the use of ethanolamine oleate for gastric varices. Surg Laparosc Endosc Percutan Tech. 2015;25(1):e27-e32.
Chikamori, F., Okamoto, H., & Kuniyoshi, N. (2015). New transjugular retrograde obliteration without the use of ethanolamine oleate for gastric varices. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 25(1), e27-e32. https://doi.org/10.1097/SLE.0000000000000031
Chikamori F, Okamoto H, Kuniyoshi N. New Transjugular Retrograde Obliteration Without the Use of Ethanolamine Oleate for Gastric Varices. Surg Laparosc Endosc Percutan Tech. 2015;25(1):e27-e32. PubMed PMID: 24743676.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - New transjugular retrograde obliteration without the use of ethanolamine oleate for gastric varices. AU - Chikamori,Fumio, AU - Okamoto,Hiroshi, AU - Kuniyoshi,Nobutoshi, PY - 2014/4/19/entrez PY - 2014/4/20/pubmed PY - 2015/12/15/medline SP - e27 EP - e32 JF - Surgical laparoscopy, endoscopy & percutaneous techniques JO - Surg Laparosc Endosc Percutan Tech VL - 25 IS - 1 N2 - OBJECTIVES: The purpose of this study was to investigate the short-term effects of new transjugular retrograde obliteration (TJO) without the use of ethanolamine oleate for gastric varices with a gastrorenal shunt. PATIENTS AND METHODS: Ten patients with gastric varices and a gastrorenal shunt were included in this study. Through the right internal jugular vein, a 5- or 6-Fr angiographic catheter with an occlusive balloon was inserted into the gastrorenal shunt. The balloon was inflated to occlude the gastrorenal shunt blood flow. Microcoils were used to obliterate the main blood drainage routes of gastric vein, such as inferior phrenic and and/or retroperitoneal veins. Continuous injection of 0.5 to 1.0 mL of absolute ethanol and 2 to 15 mL of 50% glucose solution into the gastrorenal shunt was carried out under fluoroscopy. This procedure was repeated at 5-minute intervals until gastric varices were clearly visualized. 5% ethanolamine oleate with iopamidol (5% EOI) was not used as a sclerosant. RESULTS: TJO without 5% EOI technically succeeded in all cases. Total volumes of absolute ethanol and 50% glucose solution for the variceal obliteration were 6±4 and 56±46 mL, respectively. To produce thrombi in the gastric varices, the catheter had to be retained for 24 hours in 7 patients and for 48 hours in 3. The volumes of absolute ethanol and 50% glucose solution were 4±2 and 37±20 in the former 7 patients and 11±4 and 100±64 mL in the latter 3 patients, respectively. Only minor complications were observed, which were as follows: fever >38°C in 6 patients, epigastric pain in 8 patients, and temporary hypertension in 2 patients. Computed tomography scan and endoscopic examination 3 months after TJO revealed complete eradication of gastric varices in all cases. CONCLUSIONS: We conclude that new TJO without the use of 5% EOI is an effective and safe method for gastric varices. SN - 1534-4908 UR - https://www.unboundmedicine.com/medline/citation/24743676/New_transjugular_retrograde_obliteration_without_the_use_of_ethanolamine_oleate_for_gastric_varices_ L2 - https://doi.org/10.1097/SLE.0000000000000031 DB - PRIME DP - Unbound Medicine ER -