Variant treatment for gastric varices with polidocanol foam using balloon-occluded retrograde transvenous obliteration: A pilot study
- W Clements MBBS, BBiomedSc(Hons); K Cavanagh BMed; F Ali MBBS; H Kavnoudias PhD; W Kemp MBBS, FRACP; S Roberts MBBS, FRACP; S Lyon MBBS, FRANZCR.
- Conflict of interest: The authors declare that they have no conflict of interest.
Associate Professor Stuart Lyon, Department of Radiology, The Alfred Hospital, Commercial Road, Prahran, Melbourne, Victoria 3181, Australia.
Treatment of gastric variceal rupture remains difficult with current options including transjugular intrahepatic portosystemic shunt and endoscopic therapies having significant side effects or reduced efficacy. We report five cases of gastric varices that were successfully treated with balloon-occluded retrograde transvenous obliteration of varices (BRTO) using Polidocanol foam as an alternative sclerosant to ethanolamine oleate.
Patients were recruited with cirrhotic liver disease, a history of upper gastrointestinal bleeding, and large gastric fundal varices confirmed on gastroscopy and CT venogram. BRTO was performed as a same-day procedure using a balloon catheter inserted via a gastro-renal shunt with Polidocanol foam injected and a balloon inflated for 2 h. Follow-up was with repeat CT portovenogram, gastroscopy at 6 weeks post-procedure, and in a gastroenterology liver clinic at 1- to 3-month intervals.
Between January and December 2009, five patients safely underwent BRTO therapy of gastric varices without complication. At 6 weeks following the procedure, upper gastrointestinal endoscopy showed complete resolution of varices in 5 out of 5 patients, while CT portovenography showed resolution of varices in 4 out of 5 patients, with results in the last patient inconclusive. Clinical follow-up at 1, 3 and 6 months indicated no further episodes of bleeding.
Our study further supports the use of foam sclerosants including Polidocanol in BRTO, showing it is a safe and effective minimally-invasive procedure to treat gastric fundal varices in the short term.