Gastric varices and hepatic encephalopathy: treatment with vascular plug and gelatin sponge-assisted retrograde transvenous obliteration--a primary report
To evaluate technical safety, clinical safety, and effectiveness of vascular plug-assisted retrograde transvenous obliteration (RTO) for treatment of gastric varices (GV) and hepatic encephalopathy (HE). This retrospective study was approved by the institutional review board; written informed consen...
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| Veröffentlicht in: | Radiology 2013-07, Vol.268 (1), p.281-287 |
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| creator | Gwon, Dong Il Ko, Gi-Young Yoon, Hyun-Ki Sung, Kyu-Bo Kim, Jin Hyoung Shin, Ji Hoon Ko, Heung Kyu Song, Ho-Young |
| description | To evaluate technical safety, clinical safety, and effectiveness of vascular plug-assisted retrograde transvenous obliteration (RTO) for treatment of gastric varices (GV) and hepatic encephalopathy (HE).
This retrospective study was approved by the institutional review board; written informed consent was waived. From April 2009 to December 2011, 20 patients (13, GV; seven, HE) who had undergone vascular plug-assisted RTO were retrospectively evaluated. After retrograde transvenous placement of a vascular plug in the left adrenal vein or gastrorenal shunt, subsequent gelatin-sponge embolization of both gastrorenal shunt and GV was performed. Follow-up computed tomography (CT) and upper gastrointestinal tract endoscopy were performed; clinical and laboratory data were collected to evaluate primary (technical success, complications, clinical success) and secondary (change of liver function by using the Child-Pugh score, worsening of esophageal varices) end points. Laboratory data before and after vascular plug-assisted RTO were compared (paired-sample t test).
Placement of the vascular plug and subsequent gelatin-sponge embolization were technically successful in all 20 patients, with no procedure-related complications. Follow-up CT within 1 week after vascular plug-assisted RTO showed complete thrombosis of GV and gastrorenal shunts in all patients. Clinical symptoms of HE completely resolved in all seven patients with HE; mean serum NH3 level of 127.4 μmol/L ± 58 (standard deviation) before vascular plug-assisted RTO decreased significantly to 28.1 μmol/L ± 9.8 within 1 week after vascular plug-assisted RTO (P = .002). Eighteen patients who underwent follow-up longer than 2 months showed complete obliteration of GV and gastrorenal shunts at CT and endoscopy. There were no cases of variceal bleeding or HE during mean follow-up of 422 days. Improvement in Child-Pugh score was observed in 12 of 18 (67%) patients 1 month after vascular plug-assisted RTO. Worsening of esophageal varices was observed in four (22%) patients at mean follow-up of 9.4 months.
Vascular plug-assisted RTO is technically simple and safe and seems to be clinically effective for treatment of GV and HE. |
| doi_str_mv | 10.1148/radiol.13122102 |
| format | Article |
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This retrospective study was approved by the institutional review board; written informed consent was waived. From April 2009 to December 2011, 20 patients (13, GV; seven, HE) who had undergone vascular plug-assisted RTO were retrospectively evaluated. After retrograde transvenous placement of a vascular plug in the left adrenal vein or gastrorenal shunt, subsequent gelatin-sponge embolization of both gastrorenal shunt and GV was performed. Follow-up computed tomography (CT) and upper gastrointestinal tract endoscopy were performed; clinical and laboratory data were collected to evaluate primary (technical success, complications, clinical success) and secondary (change of liver function by using the Child-Pugh score, worsening of esophageal varices) end points. Laboratory data before and after vascular plug-assisted RTO were compared (paired-sample t test).
Placement of the vascular plug and subsequent gelatin-sponge embolization were technically successful in all 20 patients, with no procedure-related complications. Follow-up CT within 1 week after vascular plug-assisted RTO showed complete thrombosis of GV and gastrorenal shunts in all patients. Clinical symptoms of HE completely resolved in all seven patients with HE; mean serum NH3 level of 127.4 μmol/L ± 58 (standard deviation) before vascular plug-assisted RTO decreased significantly to 28.1 μmol/L ± 9.8 within 1 week after vascular plug-assisted RTO (P = .002). Eighteen patients who underwent follow-up longer than 2 months showed complete obliteration of GV and gastrorenal shunts at CT and endoscopy. There were no cases of variceal bleeding or HE during mean follow-up of 422 days. Improvement in Child-Pugh score was observed in 12 of 18 (67%) patients 1 month after vascular plug-assisted RTO. Worsening of esophageal varices was observed in four (22%) patients at mean follow-up of 9.4 months.
Vascular plug-assisted RTO is technically simple and safe and seems to be clinically effective for treatment of GV and HE.</description><identifier>ISSN: 0033-8419</identifier><identifier>EISSN: 1527-1315</identifier><identifier>DOI: 10.1148/radiol.13122102</identifier><identifier>PMID: 23481167</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Embolization, Therapeutic - instrumentation ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices - therapy ; Female ; Gelatin Sponge, Absorbable - therapeutic use ; Hepatic Encephalopathy - therapy ; Humans ; Liver Function Tests ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome</subject><ispartof>Radiology, 2013-07, Vol.268 (1), p.281-287</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c330t-38d8f6305283e02977f30657896de7ed481bd1a2d10931a76db7a7c2019960d13</citedby><cites>FETCH-LOGICAL-c330t-38d8f6305283e02977f30657896de7ed481bd1a2d10931a76db7a7c2019960d13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23481167$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gwon, Dong Il</creatorcontrib><creatorcontrib>Ko, Gi-Young</creatorcontrib><creatorcontrib>Yoon, Hyun-Ki</creatorcontrib><creatorcontrib>Sung, Kyu-Bo</creatorcontrib><creatorcontrib>Kim, Jin Hyoung</creatorcontrib><creatorcontrib>Shin, Ji Hoon</creatorcontrib><creatorcontrib>Ko, Heung Kyu</creatorcontrib><creatorcontrib>Song, Ho-Young</creatorcontrib><title>Gastric varices and hepatic encephalopathy: treatment with vascular plug and gelatin sponge-assisted retrograde transvenous obliteration--a primary report</title><title>Radiology</title><addtitle>Radiology</addtitle><description>To evaluate technical safety, clinical safety, and effectiveness of vascular plug-assisted retrograde transvenous obliteration (RTO) for treatment of gastric varices (GV) and hepatic encephalopathy (HE).
This retrospective study was approved by the institutional review board; written informed consent was waived. From April 2009 to December 2011, 20 patients (13, GV; seven, HE) who had undergone vascular plug-assisted RTO were retrospectively evaluated. After retrograde transvenous placement of a vascular plug in the left adrenal vein or gastrorenal shunt, subsequent gelatin-sponge embolization of both gastrorenal shunt and GV was performed. Follow-up computed tomography (CT) and upper gastrointestinal tract endoscopy were performed; clinical and laboratory data were collected to evaluate primary (technical success, complications, clinical success) and secondary (change of liver function by using the Child-Pugh score, worsening of esophageal varices) end points. Laboratory data before and after vascular plug-assisted RTO were compared (paired-sample t test).
Placement of the vascular plug and subsequent gelatin-sponge embolization were technically successful in all 20 patients, with no procedure-related complications. Follow-up CT within 1 week after vascular plug-assisted RTO showed complete thrombosis of GV and gastrorenal shunts in all patients. Clinical symptoms of HE completely resolved in all seven patients with HE; mean serum NH3 level of 127.4 μmol/L ± 58 (standard deviation) before vascular plug-assisted RTO decreased significantly to 28.1 μmol/L ± 9.8 within 1 week after vascular plug-assisted RTO (P = .002). Eighteen patients who underwent follow-up longer than 2 months showed complete obliteration of GV and gastrorenal shunts at CT and endoscopy. There were no cases of variceal bleeding or HE during mean follow-up of 422 days. Improvement in Child-Pugh score was observed in 12 of 18 (67%) patients 1 month after vascular plug-assisted RTO. Worsening of esophageal varices was observed in four (22%) patients at mean follow-up of 9.4 months.
Vascular plug-assisted RTO is technically simple and safe and seems to be clinically effective for treatment of GV and HE.</description><subject>Aged</subject><subject>Embolization, Therapeutic - instrumentation</subject><subject>Endoscopy, Gastrointestinal</subject><subject>Esophageal and Gastric Varices - therapy</subject><subject>Female</subject><subject>Gelatin Sponge, Absorbable - therapeutic use</subject><subject>Hepatic Encephalopathy - therapy</subject><subject>Humans</subject><subject>Liver Function Tests</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><issn>0033-8419</issn><issn>1527-1315</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUFP3DAQha0K1N1Cz70hH7kEPHZiJ71VqGwrIXGBczQbz-6m8trBdqj4K_zauuzSay8zGut9TzN-jH0BcQVQt9cR7RjcFSiQEoT8wJbQSFOVuTlhSyGUqtoaugX7lNIvIaBuWvORLaSqWwBtlux1hSnHceDPWColjt7yHU2Yyxv5gaYdulDG3ctXniNh3pPP_PeYdwVJw-ww8snN2zdwS66Anqcp-C1VmNKYMlkeKcewLctS8UCfnsmHOfGwdmOmWJDgqwr5FMc9xpcin0LM5-x0gy7R52M_Y4-33x9uflR396ufN9_uqkEpkSvV2najlWhkq0jIzpiNEroxbactGbLl0rUFlBZEpwCNtmuDZpACuk4LC-qMXR58pxieZkq5349pIOfQU9myB61FXT5bi_9LlQFppGxMkV4fpEMMKUXa9MfrehD93-z6Q3b9e3aFuDiaz-s92X_697DUHyqqmQI</recordid><startdate>201307</startdate><enddate>201307</enddate><creator>Gwon, Dong Il</creator><creator>Ko, Gi-Young</creator><creator>Yoon, Hyun-Ki</creator><creator>Sung, Kyu-Bo</creator><creator>Kim, Jin Hyoung</creator><creator>Shin, Ji Hoon</creator><creator>Ko, Heung Kyu</creator><creator>Song, Ho-Young</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7TK</scope></search><sort><creationdate>201307</creationdate><title>Gastric varices and hepatic encephalopathy: treatment with vascular plug and gelatin sponge-assisted retrograde transvenous obliteration--a primary report</title><author>Gwon, Dong Il ; Ko, Gi-Young ; Yoon, Hyun-Ki ; Sung, Kyu-Bo ; Kim, Jin Hyoung ; Shin, Ji Hoon ; Ko, Heung Kyu ; Song, Ho-Young</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c330t-38d8f6305283e02977f30657896de7ed481bd1a2d10931a76db7a7c2019960d13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Embolization, Therapeutic - instrumentation</topic><topic>Endoscopy, Gastrointestinal</topic><topic>Esophageal and Gastric Varices - therapy</topic><topic>Female</topic><topic>Gelatin Sponge, Absorbable - therapeutic use</topic><topic>Hepatic Encephalopathy - therapy</topic><topic>Humans</topic><topic>Liver Function Tests</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gwon, Dong Il</creatorcontrib><creatorcontrib>Ko, Gi-Young</creatorcontrib><creatorcontrib>Yoon, Hyun-Ki</creatorcontrib><creatorcontrib>Sung, Kyu-Bo</creatorcontrib><creatorcontrib>Kim, Jin Hyoung</creatorcontrib><creatorcontrib>Shin, Ji Hoon</creatorcontrib><creatorcontrib>Ko, Heung Kyu</creatorcontrib><creatorcontrib>Song, Ho-Young</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Neurosciences Abstracts</collection><jtitle>Radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gwon, Dong Il</au><au>Ko, Gi-Young</au><au>Yoon, Hyun-Ki</au><au>Sung, Kyu-Bo</au><au>Kim, Jin Hyoung</au><au>Shin, Ji Hoon</au><au>Ko, Heung Kyu</au><au>Song, Ho-Young</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Gastric varices and hepatic encephalopathy: treatment with vascular plug and gelatin sponge-assisted retrograde transvenous obliteration--a primary report</atitle><jtitle>Radiology</jtitle><addtitle>Radiology</addtitle><date>2013-07</date><risdate>2013</risdate><volume>268</volume><issue>1</issue><spage>281</spage><epage>287</epage><pages>281-287</pages><issn>0033-8419</issn><eissn>1527-1315</eissn><abstract>To evaluate technical safety, clinical safety, and effectiveness of vascular plug-assisted retrograde transvenous obliteration (RTO) for treatment of gastric varices (GV) and hepatic encephalopathy (HE).
This retrospective study was approved by the institutional review board; written informed consent was waived. From April 2009 to December 2011, 20 patients (13, GV; seven, HE) who had undergone vascular plug-assisted RTO were retrospectively evaluated. After retrograde transvenous placement of a vascular plug in the left adrenal vein or gastrorenal shunt, subsequent gelatin-sponge embolization of both gastrorenal shunt and GV was performed. Follow-up computed tomography (CT) and upper gastrointestinal tract endoscopy were performed; clinical and laboratory data were collected to evaluate primary (technical success, complications, clinical success) and secondary (change of liver function by using the Child-Pugh score, worsening of esophageal varices) end points. Laboratory data before and after vascular plug-assisted RTO were compared (paired-sample t test).
Placement of the vascular plug and subsequent gelatin-sponge embolization were technically successful in all 20 patients, with no procedure-related complications. Follow-up CT within 1 week after vascular plug-assisted RTO showed complete thrombosis of GV and gastrorenal shunts in all patients. Clinical symptoms of HE completely resolved in all seven patients with HE; mean serum NH3 level of 127.4 μmol/L ± 58 (standard deviation) before vascular plug-assisted RTO decreased significantly to 28.1 μmol/L ± 9.8 within 1 week after vascular plug-assisted RTO (P = .002). Eighteen patients who underwent follow-up longer than 2 months showed complete obliteration of GV and gastrorenal shunts at CT and endoscopy. There were no cases of variceal bleeding or HE during mean follow-up of 422 days. Improvement in Child-Pugh score was observed in 12 of 18 (67%) patients 1 month after vascular plug-assisted RTO. Worsening of esophageal varices was observed in four (22%) patients at mean follow-up of 9.4 months.
Vascular plug-assisted RTO is technically simple and safe and seems to be clinically effective for treatment of GV and HE.</abstract><cop>United States</cop><pmid>23481167</pmid><doi>10.1148/radiol.13122102</doi><tpages>7</tpages></addata></record> |
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| subjects | Aged Embolization, Therapeutic - instrumentation Endoscopy, Gastrointestinal Esophageal and Gastric Varices - therapy Female Gelatin Sponge, Absorbable - therapeutic use Hepatic Encephalopathy - therapy Humans Liver Function Tests Male Middle Aged Retrospective Studies Tomography, X-Ray Computed Treatment Outcome |
| title | Gastric varices and hepatic encephalopathy: treatment with vascular plug and gelatin sponge-assisted retrograde transvenous obliteration--a primary report |
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