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Saeki M, Okubo H, Takasaki Y, Nakadera E, Fukuo Y, Fukada H, Hotchi Y, Maruyama H, Kokubu S, Shiina S, Nagahara A, Ikejima K. The Impact of Partial Splenic Embolization on Portal Hypertensive Gastropathy in Cirrhotic Patients with Portal Hypertension. J Clin Med 2023; 12:jcm12072662. [PMID: 37048744 PMCID: PMC10094775 DOI: 10.3390/jcm12072662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/01/2023] [Accepted: 04/02/2023] [Indexed: 04/05/2023] Open
Abstract
This study investigated the impact of partial splenic embolization (PSE) on portal hypertensive gastropathy (PHG). We retrospectively analyzed endoscopic findings and the portal venous system of 31 cirrhotic patients with PHG. The improved group was defined as the amelioration of PHG findings using the McCormack classification. Child–Pugh scores of the improved group (18 of 31 patients) were significantly lower compared with those of the non-improved group (p = 0.018). The changes in the diameters of the portal trunk and those of the spleno-portal junction and spleen hilum in the splenic vein of the improved group were significantly larger than those of the non-improved group (p = 0.007, p = 0.025, and p = 0.003, respectively). The changes in the diameters of the portal vein and splenic hilum of the splenic vein showed significant correlations with Child–Pugh score (r = 0.386, p = 0.039; r = 0.510, p = 0.004). In a multivariate analysis of baseline factors related to the improved group, Child–Pugh grade A was significantly associated with the improvement of PHG (odds ratio 6.875, p = 0.033). PSE could be useful for PHG, especially in patients with Child–Pugh grade A, at least in the short term.
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Affiliation(s)
- Michio Saeki
- Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Hironao Okubo
- Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan
| | - Yusuke Takasaki
- Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Eisuke Nakadera
- Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Yuka Fukuo
- Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Hiroo Fukada
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan
| | - Yuta Hotchi
- Department of Emergency Medicine, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Hitoshi Maruyama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan
| | - Shigehiro Kokubu
- Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
- Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki 215-0026, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan
| | - Kenichi Ikejima
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan
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Khakwani A, Trivedi M, Afzal M, Kahlon P, Patel P, Chirumamilla PC, Vohra RR, Ratheesh R, Mathew M, Abdin ZU, Nazir Z. Use of Balloon Occluded Retrograde Transvenous Obliteration (BRTO) for Treatment of Gastric Varices: A Narrative Review. Cureus 2023; 15:e38233. [PMID: 37257163 PMCID: PMC10225054 DOI: 10.7759/cureus.38233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
Gastric Varices occur as a result of portal hypertension. Balloon Retrograde Transvenous Obliteration (BRTO) is a modality for managing gastric varices. The ultimate goal of this review is to promote the broader adoption of BRTO in managing gastric varices and to promote further research to improve patient outcomes. Before this study, an electronic literature search was undertaken based on identified concepts, keywords, and other pertinent descriptions. Search databases were developed and included "Gastric varices" AND "BRTO" OR "intervention" OR "treatment" OR "procedure" OR "glue" OR "adhesive". The databases selected and thoroughly searched were PubMed, Cochrane Library and ScienceDirect. Following the first search, 274 articles were found in total. By applying inclusion criteria of full-text articles and a period of fewer than five years, the database was reduced to 37 articles, which was then further filtered to include only articles on adults over 19 years old, leaving a total count of 17 articles. BRTO is a relatively simple procedure to perform once the essential skill is attained and helpful in both emergency and elective management of gastric varices. Its use still needs to be improved by the unavailability and lack of skills. However, there are side effects associated with BRTO as it causes elevation of portal hypertension, recurrent bleeding, hemoglobinuria and pain post procedure. This review emphasizes the need for further research in this field, focusing on refining patient selection criteria, improving the technical aspect of the procedure and enhancing long-term outcomes.
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Affiliation(s)
- Anum Khakwani
- Internal Medicine/Gastroenterology, Nishtar Medical University, Multan, PAK
| | - Manan Trivedi
- Department of Surgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Maham Afzal
- Medicine and Surgery, Shalamar Medical and Dental College, Lahore, PAK
| | - Puneet Kahlon
- Medicine, American International Medical University, Gros Islet, LCA
| | - Parakh Patel
- Medicine, American International Medical University, Gros Islet, LCA
| | | | - Rimsha R Vohra
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Rani Ratheesh
- Internal Medicine, Dr MGR Medical University, Tamilnadu, IND
| | - Midhun Mathew
- Department of Internal Medicine, Pennsylvania Hospital, Philadelphia, USA
| | - Zain U Abdin
- Medicine, District Head Quarter Hospital, Faisalabad, PAK
| | - Zahra Nazir
- Internal Medicine/Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Chen XL, Yao X, Yang GD, Qin JP. Applications of vascular interventions in hypersplenism in liver cirrhosis. Shijie Huaren Xiaohua Zazhi 2022; 30:140-146. [DOI: 10.11569/wcjd.v30.i3.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cirrhosis is a common cause of secondary hypersplenism. Hypersplenism often leads to a decrease in peripheral blood cells, and when the numbers of leukocytes and platelets are severely reduced, patients are prone to spontaneous infections and bleeding, which can aggravate the disease and increase the risk of death. The mechanism of hypersplenism in cirrhosis is not well understood, and there is no standard indication or recommended method for the treatment of hypersplenism. Clinical treatment options for hypersplenism include splenectomy, vascular intervention, local thermal ablation, and splenic artery ligation. Vascular interventions mainly involve transjugular intrahepatic portosystemic shunt (TIPS) and partial splenic embolization (PSE). TIPS is an effective method to treat the complications of portal hypertension in cirrhosis, which can effectively reduce portal pressure, but whether it can relieve hypersplenism is still controversial. PSE can relieve hypersplenism to a certain extent. TIPS combined with PSE can effectively reduce portal hypertension and relieve hypersplenism to a certain extent. This article reviews the applications of vascular interventions in hypersplenism in cirrhosis.
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Affiliation(s)
- Xue-Ling Chen
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Xin Yao
- Department of Gastroenterology, General Hospital of Western War Zone, Chinese People's Liberation Army, Chengdu 610083, Sichuan Province, China
| | - Guo-Dong Yang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Jian-Ping Qin
- Department of Gastroenterology, General Hospital of Western War Zone, Chinese People's Liberation Army, Chengdu 610083, Sichuan Province, China
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Waguri N, Osaki A, Watanabe Y, Matsubara T, Yamazaki S, Yokoyama H, Kimura K, Wakabayashi T, Mito M, Yakubo S, Azumi R, Kohisa J, Takaku K, Sato M, Furukawa K. Balloon-occluded retrograde transvenous obliteration for gastric varices improves hepatic functional reserve in long-term follow-up. JGH Open 2021; 5:1328-1334. [PMID: 34950775 PMCID: PMC8674543 DOI: 10.1002/jgh3.12675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/22/2021] [Accepted: 11/01/2021] [Indexed: 12/17/2022]
Abstract
Background and Aim Balloon‐occluded retrograde transvenous obliteration (BRTO) has been widely adopted for the management of gastric fundal varices (GVs). There are a few reports that BRTO leads to the improvement of mid‐term and long‐term hepatic functional reserve (HFR). We retrospectively investigated the long‐term effect on HFR and prognosis among patients who had undergone BRTO for GVs. Methods This single‐center, retrospective study included 57successful patients out of 60 patients who underwent BRTO for GVs from December 2005 to September 2018. We examined the indicators of HFR (e.g., encephalopathy and ascites statuses, serum total bilirubin and albumin levels, % prothrombin time, and Child–Pugh and albumin–bilirubin [ALBI] scores) during 3 years of follow‐up after BRTO. We analyzed survival using the Kaplan–Meier method and identified the independent prognostic factors via multivariate analyses. Results GVs disappeared in all patients who were successfully treated by BRTO. At 3 years after BRTO, serum albumin levels were significantly elevated (from 3.3 to 4.0 g/dL, P = 0.008), while Child–Pugh and ALBI scores were significantly decreased (from 7.0 to 5.7, P = 0.043, and from −1.94 to −2.60, P = 0.006, respectively). The median survival time among all patients was 2207 days; the survival rates after BRTO were 87.0% at 1 year, 81.8% at 3 years, 67.3% at 5 years, and 44.1% at 10 years. Multivariate analyses revealed that ascites, hepatic encephalopathy, and malignant neoplasms were independently associated with poor prognosis. Conclusion BRTO for GVs has a favorable effect on long‐term HFR.
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Affiliation(s)
- Nobuo Waguri
- Department of Gastroenterology and Hepatology Niigata City General Hospital Niigata Japan
| | - Akihiko Osaki
- Department of Gastroenterology and Hepatology Niigata City General Hospital Niigata Japan
| | - Yusuke Watanabe
- Department of Gastroenterology and Hepatology Niigata City General Hospital Niigata Japan
| | - Tsuyoshi Matsubara
- Department of Gastroenterology and Hepatology Niigata City General Hospital Niigata Japan
| | - Shun Yamazaki
- Department of Gastroenterology and Hepatology Niigata City General Hospital Niigata Japan
| | - Hanako Yokoyama
- Department of Gastroenterology and Hepatology Niigata City General Hospital Niigata Japan
| | - Kiwamu Kimura
- Department of Gastroenterology and Hepatology Niigata City General Hospital Niigata Japan
| | - Takuya Wakabayashi
- Department of Gastroenterology and Hepatology Niigata City General Hospital Niigata Japan
| | - Masaki Mito
- Department of Gastroenterology and Hepatology Niigata City General Hospital Niigata Japan
| | - Shunta Yakubo
- Department of Gastroenterology and Hepatology Niigata City General Hospital Niigata Japan
| | - Rie Azumi
- Department of Gastroenterology and Hepatology Niigata City General Hospital Niigata Japan
| | - Junji Kohisa
- Department of Gastroenterology and Hepatology Niigata City General Hospital Niigata Japan
| | - Kennichi Takaku
- Department of Gastroenterology and Hepatology Niigata City General Hospital Niigata Japan
| | - Munehiro Sato
- Department of Gastroenterology and Hepatology Niigata City General Hospital Niigata Japan
| | - Kouichi Furukawa
- Department of Gastroenterology and Hepatology Niigata City General Hospital Niigata Japan
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Yonezawa H, Jogo A, Yamamoto A, Nota T, Murai K, Ogawa S, Nakano M, Kageyama K, Hamamoto S, Sohgawa E, Hamuro M, Kaminou T, Miki Y. A case of venous aneurysm of a splenorenal shunt. BJR Case Rep 2021; 7:20210011. [PMID: 35136621 PMCID: PMC8803243 DOI: 10.1259/bjrcr.20210011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/29/2021] [Accepted: 05/24/2021] [Indexed: 12/29/2022] Open
Abstract
A 66-year-old man presented with liver cirrhosis due to non-alcoholic steatohepatitis and hyperammonemia. Contrast-enhanced CT showed a dilated and tortuous splenorenal shunt and a large venous aneurysm in the shunt. The venous aneurysm showed gradual enlargement over 10 years and worsening hyperammonemia, so balloon-occluded retrograde transvenous obliteration was performed. Under balloon occlusion, 5% ethanolamine oleate was injected from a microcatheter into the venous aneurysm, which was subsequently embolized with microcoils. Contrast-enhanced CT after the procedure showed complete thrombosis of the venous aneurysm. 10 months later, the venous aneurysm reduced in size, and hyperammonemia had improved.
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Affiliation(s)
- Hiroki Yonezawa
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan
| | - Atsushi Jogo
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan
| | - Takehito Nota
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan
| | - Kazuki Murai
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan
| | - Satoyuki Ogawa
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan
| | - Mariko Nakano
- Department of Radiology, National Hospital Organization Osaka Minami Medical Center, Kawachinagano-shi, Osaka, Japan
| | - Ken Kageyama
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan
| | - Shinichi Hamamoto
- Department of Radiology, Osaka City General Hospital, Miyakojima-ku, Osaka, Japan
| | - Etsuji Sohgawa
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan
| | - Masao Hamuro
- Department of Radiology, Izumiotsu Municipal Hospital, Izumiotsu-shi, Osaka, Japan
| | - Toshio Kaminou
- Advanced Imaging & Minimally Invasive Therapy Center, Tsukazaki Hospital, Himeji-shi, Hyogo, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan
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Waguri N, Osaki A, Watanabe Y. Balloon-occluded retrograde transvenous obliteration for treatment of gastric varices. World J Hepatol 2021; 13:650-661. [PMID: 34239700 PMCID: PMC8239489 DOI: 10.4254/wjh.v13.i6.650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/12/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
Rupture of gastric varices (GVs) can be fatal. Balloon-occluded retrograde transvenous obliteration (BRTO), as known as retrograde sclerotherapy, has been widely adopted for treatment of GVs because of its effectiveness, ability to cure, and utility in emergency and prophylactic treatment. Simplifying the route of blood flow from GVs to the gastrorenal shunt is important for the successful BRTO. This review outlines BRTO indications and contraindications, describes basic BRTO procedures and modifications, compares BRTO with other GVs treatments, and discusses various combination therapies. Combined BRTO and partial splenic embolization may prevent exacerbation of esophageal varices and shows promise as a treatment option.
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Affiliation(s)
- Nobuo Waguri
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata 950-1197, Japan
| | - Akihiko Osaki
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata 950-1197, Japan
| | - Yusuke Watanabe
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata 950-1197, Japan
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Watanabe Y, Osaki A, Waguri N, Terai S. The first case of balloon-occluded retrograde transvenous obliteration and partial splenic embolization for gastric varices in situs inversus abdominus. Clin J Gastroenterol 2021; 14:656-661. [PMID: 33403531 PMCID: PMC8016758 DOI: 10.1007/s12328-020-01332-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022]
Abstract
Situs inversus abdominus is a congenital abnormality characterized by the mirror image positioning of the abdominal organs, making it difficult to diagnosis and treatment of many diseases. Here, we report a rare case of gastric varices in situs inversus abdominus patient. A 55-year-old man was diagnosed with F2-shaped gastric varices associated with alcoholic cirrhosis. Abdominal dynamic computed tomography showed situs inversus abdominus, and gastric varices with a gastrorenal shunt. Due to the complex anatomy, emergency interventional radiology during bleeding was extremely difficult. Therefore, after thorough consultation, we decided to treat gastric varices prophylactically by balloon-occluded retrograde transvenous obliteration. After treatment, the patient’s clinical course was generally good, with no adverse events, and the gastric varices disappeared. It is important to assess anatomical positioning using three-dimensional reconstruction computed tomography images before treatment, to adequately prepare, including selecting appropriate devices (i.e., catheters and sheath). Although preventive treatment of gastric varices is controversial, in cases with anatomical complexity, preventive treatment with sufficient preparation would be recommended. To the best of our knowledge, there are no reports of treatment for gastric varices in situs inversus abdominus patient. This case will serve as a reference for successful treatment in future cases.
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Affiliation(s)
- Yusuke Watanabe
- Division of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan. .,Division of Preemptive Medicine for Digestive Disease and Healthy Active Life, School of Medicine, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
| | - Akihiko Osaki
- Division of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan
| | - Nobuo Waguri
- Division of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Kim CY, Pinchot JW, Ahmed O, Braun AR, Cash BD, Feig BW, Kalva SP, Knavel Koepsel EM, Scheidt MJ, Schramm K, Sella DM, Weiss CR, Hohenwalter EJ. ACR Appropriateness Criteria® Radiologic Management of Gastric Varices. J Am Coll Radiol 2020; 17:S239-S254. [PMID: 32370968 DOI: 10.1016/j.jacr.2020.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 12/13/2022]
Abstract
Hemorrhage, resulting from gastric varies, can be challenging to treat, given the various precipitating etiologies. A wide variety of treatment options exist for managing the diverse range of the underlying disease processes. While cirrhosis is the most common cause for gastric variceal bleeding, occlusion of the portal or splenic vein in noncirrhotic states results in a markedly different treatment paradigm. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Charles Y Kim
- Duke University Medical Center, Durham, North Carolina.
| | | | | | - Aaron R Braun
- St Elizabeth Regional Medical Center, Lincoln, Nebraska
| | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Barry W Feig
- The University of Texas MD Anderson Cancer Center, Houston, Texas; American College of Surgeons
| | | | | | | | - Kristofer Schramm
- University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Eric J Hohenwalter
- Specialty Chair, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
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Li YH, Wu JF, Wu HM, Wu XN, Xu Y, Wan YM. The Effect of Transjugular Intrahepatic Portosystemic Shunt Plus Partial Splenic Embolization for the Treatment of Patients with Recurrent Variceal Bleeding. Acad Radiol 2020; 27:323-331. [PMID: 31147236 DOI: 10.1016/j.acra.2019.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES Transjugular intrahepatic portosystemic shunt (TIPS) and partial splenic embolization (PSE) were two interventional therapies effective for the management of variceal bleeding with cirrhosis. This study aimed to investigate the effect of TIPS plus PSE for the treatment of patients with cirrhosis and recurrent variceal bleeding. MATERIAL AND METHODS This is a single-center, nonrandomized and retrospective study that included 32 patients undergoing TIPS alone (the TIPS group) and 16 patients undergoing TIPS plus PSE (the TIPS+PSE group). RESULTS The 5-year cumulative rates of variceal rebleeding (20.0% vs. 37.9%, p = 0.027) and shunt stenosis (35.1% vs. 55.9%, p = 0.036) in the TIPS+PSE group were significantly lower than in the TIPS group, whereas the 5-year cumulative rates of shunt blockage (12.5% vs. 25.8%, p = 0.388), and all-cause mortality (37.5% vs. 69.3%, p = 0.414) were not statistically different between the two groups. The 2-year cumulative rate of remaining free of hepatic encephalopathy was also similar between the two groups (75.0% vs. 81.3%, p = 0.704). Cox-regression analyses showed that group and reduction of portal venous pressure before and after TIPS creation were associated with both variceal rebleeding and shunt stenosis, whereas only reduction of portal venous pressure (hazard ratio 0.648, 95% confidence interval: 0.444-0.946, p = 0.025) was associated with shunt blockage. No severe adverse event was observed in the two groups. CONCLUSION TIPS+PSE is superior to TIPS alone in control of variceal rebleeding and shunt stenosis. Further prospective studies are warranted to confirm our findings.
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Affiliation(s)
- Yu-Hua Li
- Gastroenterology Department II or Hepatology Center, The 2nd Affiliated Hospital of Kunming Medical University, Dianming Avenue, No 374, Kunming, Yunnan 650101, China
| | - Jie-Fang Wu
- Gastroenterology Department II or Hepatology Center, The 2nd Affiliated Hospital of Kunming Medical University, Dianming Avenue, No 374, Kunming, Yunnan 650101, China
| | - Hua-Mei Wu
- Gastroenterology Department II or Hepatology Center, The 2nd Affiliated Hospital of Kunming Medical University, Dianming Avenue, No 374, Kunming, Yunnan 650101, China
| | - Xi-Nan Wu
- Public Health Institute of Kunming Medical University, Kunming, Yunnan, China
| | - Ying Xu
- Gastroenterology Department II or Hepatology Center, The 2nd Affiliated Hospital of Kunming Medical University, Dianming Avenue, No 374, Kunming, Yunnan 650101, China
| | - Yue-Meng Wan
- Gastroenterology Department II or Hepatology Center, The 2nd Affiliated Hospital of Kunming Medical University, Dianming Avenue, No 374, Kunming, Yunnan 650101, China; Public Health Institute of Kunming Medical University, Kunming, Yunnan, China.
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10
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Comparison of TIPS alone and combined with partial splenic embolization (PSE) for the management of variceal bleeding. Eur Radiol 2019; 29:5032-5041. [PMID: 30796573 DOI: 10.1007/s00330-019-06046-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/31/2018] [Accepted: 01/24/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Transjugular intrahepatic portosystemic shunt (TIPS) and partial splenic embolization (PSE) were two interventional radiological treatments for the complications of cirrhosis. This study aimed to investigate the effects of concomitant PSE on the long-term shunt patency and overall survival of TIPS-treated patients. METHODS Forty-eight patients with TIPS insertion were enrolled and studied retrospectively. They were divided into TIPS+PSE (n = 16) and TIPS groups (n = 32), undergoing combined therapy using TIPS and PSE, and monotherapy using TIPS alone, respectively. RESULTS The 5-year cumulative primary patency rate in the TIPS+PSE group was markedly higher than in the TIPS group (56.8% vs. 32.8%, p = 0.028), whereas the 5-year cumulative secondary patency rate (93.8% vs. 87.7%, p = 0.749) and overall survival rate (62.5% vs. 30.7%, p = 0.414) were not significantly different between the two groups. Cox-regression models revealed that group (hazard ratio [HR], 0.235; 95% CI, 0.084-0.665; p = 0.006), portal venous pressure decline (HR, 0.687; 95% CI, 0.563-0.838; p = 0.000), and baseline portal vein thrombosis (HR, 3.955; 95% CI, 1.634-9.573; p = 0.002) were significant predictors for shunt dysfunction, while only ascites (HR, 2.941; 95% CI, 1.250-6.920; p = 0.013) was a significant predictor for mortality. No severe adverse event was noted in the two groups except for the potential risk of splenic abscess development in the TIPS+PSE group. CONCLUSIONS Concomitant PSE may help increase the long-term primary shunt patency rate, but not the overall survival of TIPS-treated patients. Further prospective studies are needed to validate these retrospective findings and to investigate the potential mechanisms. KEY POINTS • Combined therapy using TIPS and PSE is associated with higher primary patency rates than TIPS alone. • Combined therapy using TIPS and PSE is associated with similar rates of secondary patency and overall survival of patients than TIPS alone. • Group (TIPS alone or TIPS+PSE), PVD, and baseline PVT are three independent predictors for shunt dysfunction, while ascites is the only independent predictor for mortality.
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Diagnosis and treatment guidelines for aberrant portal hemodynamics: The Aberrant Portal Hemodynamics Study Group supported by the Ministry of Health, Labor and Welfare of Japan. Hepatol Res 2017; 47:373-386. [PMID: 28058764 DOI: 10.1111/hepr.12862] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 12/29/2016] [Accepted: 01/04/2017] [Indexed: 12/18/2022]
Abstract
Idiopathic portal hypertension (IPH), causing aberrant portal hemodynamics, is a disease with an as yet unidentified cause and no established treatment protocol. The Japanese research group on IPH in Japan was set up in 1975 by the Ministry of Health, Labor and Welfare. Extrahepatic portal obstruction and Budd-Chiari syndrome (BCS) have since been added to the group's research subjects. The aims of the research group are to accurately evaluate the current status of the three diseases in Japan, elucidate their etiology and pathogenesis, and develop new treatments. Due to the long-term efforts of the Japanese research group, aberrant portal hemodynamics has been investigated in a variety of aspects, from epidemiological and pathological studies to molecular biology analyses. As a result, it has been shown that there are abnormal genes in the liver, specific for IPH. In addition, pathological findings of BCS were internationally compared and the difference in findings between Japan and Europe (or North America) has been clarified. Furthermore, it was found that complication rates of hepatocellular carcinoma in BCS were higher in Japan. Based on the research, "Diagnosis and treatment of aberrant portal hemodynamics (2001)", including diagnostic criteria for aberrant portal hemodynamics, was published in 2001. In 2013, it was revised to "Diagnosis and treatment guidelines for aberrant portal hemodynamics (2013)" after the incorporation of diagnosis and treatment in accordance with its current status.
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12
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Wang P, Liu R, Tong L, Zhang Y, Yue T, Qiao H, Zhang F, Sun X. Partial splenic embolization has beneficial effects for the management of gastroesophageal variceal hemorrhage. Saudi J Gastroenterol 2016; 22:399-406. [PMID: 27976634 PMCID: PMC5184739 DOI: 10.4103/1319-3767.195553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Partial splenic embolization (PSE) is used in the management of gastroesophageal variceal hemorrhage (GEVH). However, it is uncertain whether it has beneficial effects for GEVH patients in preventing variceal recurrence and variceal hemorrhage, as well as promoting overall survival (OS), when it is combined with conventional therapies. MATERIALS AND METHODS The databases including PubMed, EMBASE, Web of Science, Google scholar, and Cochrane Central Register of Controlled Trials were searched up to 11th of November, 2015. Meta-analyses were performed by using Review Manager 5.3 software for analyzing the risk of bias, Newcastle-Ottawa Scale for assessing the bias of cohort studies, and GRADEprofiler software for assessing outcomes obtained from the meta-analyses. RESULTS A total of 1505 articles were reviewed, and 1 randomized controlled trial and 5 cohort studies with 244 participants were eligible for inclusion. The pooled hazard ratio (HR) of variceal recurrence is 0.50 (95% confidence interval (CI) 0.37, 0.68; P< 0.00001; I2 = 0%). The pooled HR of variceal hemorrhage is 0.24 (95% CI 0.15, 0.39; P< 0.00001; I2 = 0%). The pooled HR of OS is 0.50 (95% CI 0.33, 0.67; P< 0.00001; I2 = 0%). Meta-analyses demonstrated statistically significant superiority of combinational therapies over conventional therapies in preventing variceal recurrence and variceal hemorrhage and prolonging OS. The complications related to PSE were mild or moderate and nonfatal. CONCLUSIONS The results indicate that PSE has beneficial effects for GEVH patients, however, future investigation with a larger number of subjects in clinical trials is warranted.
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Affiliation(s)
- Ping Wang
- The Hepatosplenic Surgery Center, The First Affiliated Hospital of Harbin Medical University, Harbin, China,Department of Interventional Radiology, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ruibo Liu
- Department of Interventional Radiology, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Liquan Tong
- Department of General Surgery, The Fifth Affiliated Hospital of Harbin Medical University, Daqing, China
| | - Yangjing Zhang
- Department of Interventional Radiology, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tongyun Yue
- Department of Interventional Radiology, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Haiquan Qiao
- The Hepatosplenic Surgery Center, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Feng Zhang
- Department of General Surgery, The Fifth Affiliated Hospital of Harbin Medical University, Daqing, China
| | - Xueying Sun
- The Hepatosplenic Surgery Center, The First Affiliated Hospital of Harbin Medical University, Harbin, China,Address for correspondence: Prof. Xueying Sun, The Hepatosplenic Surgery Center, The First Affiliated Hospital of Harbin Medical University, Harbin - 150001, China. E-mail:
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Madoff DC, Gaba RC, Weber CN, Clark TWI, Saad WE. Portal Venous Interventions: State of the Art. Radiology 2016; 278:333-53. [PMID: 26789601 DOI: 10.1148/radiol.2015141858] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In recent decades, there have been numerous advances in the management of liver cancer, cirrhosis, and diabetes mellitus. Although these diseases are wide ranging in their clinical manifestations, each can potentially be treated by exploiting the blood flow dynamics within the portal venous system, and in some cases, adding cellular therapies. To aid in the management of these disease states, minimally invasive transcatheter portal venous interventions have been developed to improve the safety of major hepatic resection, to reduce the untoward effects of sequelae from end-stage liver disease, and to minimize the requirement of exogenously administered insulin for patients with diabetes mellitus. This state of the art review therefore provides an overview of the most recent data and strategies for utilization of preoperative portal vein embolization, transjugular intrahepatic portosystemic shunt placement, balloon retrograde transvenous obliteration, and islet cell transplantation.
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Affiliation(s)
- David C Madoff
- From the Department of Radiology, Division of Interventional Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, P-518, New York, NY 10065 (D.C.M.); Department of Radiology, Interventional Radiology Section, University of Illinois Hospital, Chicago, Ill (R.C.G.); Department of Radiology, University of Pennsylvania School of Medicine, Penn Presbyterian Medical Center, Philadelphia, Pa (C.N.W., T.W.I.C.); and Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, Ann Arbor, Mich (W.E.S.)
| | - Ron C Gaba
- From the Department of Radiology, Division of Interventional Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, P-518, New York, NY 10065 (D.C.M.); Department of Radiology, Interventional Radiology Section, University of Illinois Hospital, Chicago, Ill (R.C.G.); Department of Radiology, University of Pennsylvania School of Medicine, Penn Presbyterian Medical Center, Philadelphia, Pa (C.N.W., T.W.I.C.); and Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, Ann Arbor, Mich (W.E.S.)
| | - Charles N Weber
- From the Department of Radiology, Division of Interventional Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, P-518, New York, NY 10065 (D.C.M.); Department of Radiology, Interventional Radiology Section, University of Illinois Hospital, Chicago, Ill (R.C.G.); Department of Radiology, University of Pennsylvania School of Medicine, Penn Presbyterian Medical Center, Philadelphia, Pa (C.N.W., T.W.I.C.); and Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, Ann Arbor, Mich (W.E.S.)
| | - Timothy W I Clark
- From the Department of Radiology, Division of Interventional Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, P-518, New York, NY 10065 (D.C.M.); Department of Radiology, Interventional Radiology Section, University of Illinois Hospital, Chicago, Ill (R.C.G.); Department of Radiology, University of Pennsylvania School of Medicine, Penn Presbyterian Medical Center, Philadelphia, Pa (C.N.W., T.W.I.C.); and Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, Ann Arbor, Mich (W.E.S.)
| | - Wael E Saad
- From the Department of Radiology, Division of Interventional Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, P-518, New York, NY 10065 (D.C.M.); Department of Radiology, Interventional Radiology Section, University of Illinois Hospital, Chicago, Ill (R.C.G.); Department of Radiology, University of Pennsylvania School of Medicine, Penn Presbyterian Medical Center, Philadelphia, Pa (C.N.W., T.W.I.C.); and Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, Ann Arbor, Mich (W.E.S.)
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Waguri N, Osaki A, Ikarashi S, Ogawa M, Kuraoka N, Ogawa K, Sato M, Aiba T, Yoneyama O, Furukawa K, Sugimura K, Igarashi K. Simultaneous combined balloon-occluded retrograde transvenous obliteration and partial splenic embolization for gastric fundal varices. United European Gastroenterol J 2015; 4:62-9. [PMID: 26966524 DOI: 10.1177/2050640615581966] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/22/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We previously reported the techniques and usefulness of simultaneous combined balloon-occluded retrograde transvenous obliteration (B-RTO) and partial splenic embolization (PSE), based on the hypothesis that concomitant PSE can diminish the increase in portal venous pressure after B-RTO. OBJECTIVE After experiencing more cases and performing longer-term follow-up, we re-evaluated the efficacy of simultaneous combined B-RTO and PSE for gastric fundal varices (GVs). METHODS We performed B-RTO in 36 consecutive patients treated for GVs from 2005 to 2013. Twenty-three patients underwent simultaneous combined B-RTO and PSE (Group 1) and 13 underwent B-RTO monotherapy (Group 2). The outcomes were retrospectively evaluated. RESULTS There were no significant differences in baseline characteristics between the two groups except that the splenic volumes were larger in Group 1 than 2. B-RTO was technically successful in 21 of 23 patients (91.3%) in Group 1 and in 12 of 13 patients (92.3%) in Group 2. In all patients with ruptured GVs (six in Group 1 and five in Group 2), complete hemostasis was obtained by B-RTO. Exacerbation of esophageal varices was significantly less frequent in Group 1 than 2 (p = 0.0017). CONCLUSION Concomitant PSE with B-RTO may contribute to prevention of the exacerbation of esophageal varices after B-RTO.
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Affiliation(s)
- Nobuo Waguri
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan
| | - Akihiko Osaki
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan
| | - Shunzo Ikarashi
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan
| | - Masahiro Ogawa
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan
| | - Naosuke Kuraoka
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan
| | - Kohei Ogawa
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan
| | - Munehiro Sato
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan
| | - Tsuneo Aiba
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan
| | - Osamu Yoneyama
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan
| | - Koichi Furukawa
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan
| | - Kazuhito Sugimura
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan
| | - Kentarou Igarashi
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan
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Inoue H, Emori K, Toyonaga A, Oho K, Kumamoto M, Haruta T, Mitsuyama K, Tsuruta O, Sata M. Long term results of balloon-occluded retrograde transvenous obliteration for portosystemic shunt encephalopathy in patients with liver cirrhosis and portal hypertension. Kurume Med J 2014; 61:1-8. [PMID: 25420513 DOI: 10.2739/kurumemedj.ms63014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study examined 19 patients with portosystemic shunt encephalopathy caused by a splenorenal shunt (SRS), which was treated with balloon-occluded retrograde transvenous obliteration (B-RTO). Long-term treatment outcomes were evaluated based on hepatic functional reserve and vital prognosis. Encephalopathy improved in all patients after shunt embolization and closure. Albumin, serum ammonia, and the Child-Pugh score, a measure of liver function, were significantly improved 3 years after B-RTO, and exacerbation of damage to liver function was avoided (p<0.01). During the follow-up period, three patients died from liver failure and two patients from hepatocellular carcinoma. Patients had a poor prognosis if their albumin levels were less than 2.8 mg / dL before B-RTO (p<0.05). Encephalopathy patients had complete response to B-RTO, but long-term prognosis was affected by hepatic functional reserve before B-RTO and by concurrent hepatocellular carcinoma. The results of this study suggest that in patients with SRS, it is important to perform B-RTO at an early stage when the hepatic functional reserve is still satisfactory.
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Affiliation(s)
- Hiroto Inoue
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine
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Naeshiro N, Kakizawa H, Aikata H, Kan H, Fujino H, Fukuhara T, Kobayashi T, Honda Y, Miyaki D, Kawaoka T, Tsuge M, Hiramatsu A, Imamura M, Kawakami Y, Hyogo H, Ishikawa M, Awai K, Chayama K. Percutaneous transvenous embolization for portosystemic shunts associated with encephalopathy: Long-term outcomes in 14 patients. Hepatol Res 2014; 44:740-9. [PMID: 23745735 DOI: 10.1111/hepr.12181] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 05/25/2013] [Accepted: 06/02/2013] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the clinical outcomes of percutaneous transvenous embolization (PTE) for portosystemic shunt (PSS) associated with encephalopathy METHODS Fourteen patients with portosystemic encephalopathy (PSE) were enrolled in this retrospective cohort study. We evaluated technical success, clinical success, complication and outcomes. RESULTS In cases in which PSS was one of main causes of PSE, three also had splenorenal shunts, four gastrorenal shunts, four superior mesenteric vein systemic shunts, one inferior mesenteric vein systemic shunt and two main trunk of portal vein inferior vena cava shunts. We used only ethanolamine oleate (EO) in five; EO and coils in five; EO, coils and n-butyl 2-cyanoacrylate (NBCA) in two; and coils and NBCA in two patients as embolic materials. The rate of primary and secondary technical success was 93% (13/14 patients) and 100%, respectively. No major complications were encountered related to PTE. Follow-up period was a median of 27 months (range, 12-79). All patients had sustained disappearance of PSE. PSE recurred in one patient because of another PSS development. Thus, clinical success was achieved in 93% (13/14 patients). The ammonia levels 1 year after PTE were significantly improved compared with pre-PTE (median, 102 vs 41 μmol/L) and maintained lower levels 2 and 3 years later. Child-Pugh scores did not change significantly. Esophageal varices were aggravated in 29% (4/14 patients). Five patients died, but no death of hepatic failure related to PTE was encountered. CONCLUSION PTE could be one of the useful treatment options for PSE.
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Affiliation(s)
- Noriaki Naeshiro
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
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Yoshimatsu R, Yamagami T, Tanaka O, Miura H, Hashiba M. Hemodynamic Changes after Balloon Occlusion of the Splenic Artery during Balloon-occluded Retrograde Transvenous Obliteration for Gastric Varices. J Vasc Interv Radiol 2012; 23:1207-12. [DOI: 10.1016/j.jvir.2012.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 06/10/2012] [Accepted: 06/11/2012] [Indexed: 12/17/2022] Open
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