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. 2010 Jul;148(1):145-50.
doi: 10.1016/j.surg.2009.10.052. Epub 2009 Dec 11.

The efficacy of balloon-occluded retrograde transvenous obliteration on small intestinal variceal bleeding

Naotaka Hashimoto  1 , Tomohiko Akahoshi, Daisuke Yoshida, Nao Kinjo, Kozo Konishi, Hideo Uehara, Yoshihiro Nagao, Hirofumi Kawanaka, Morimasa Tomikawa, Yoshihiko Maehara
Affiliations

The efficacy of balloon-occluded retrograde transvenous obliteration on small intestinal variceal bleeding

Naotaka Hashimoto et al. Surgery. 2010 Jul.

Abstract

Background: Small intestinal variceal bleeding is an unusual cause of gastrointestinal hemorrhaging of portal hypertensive patients, but once it occurs it may lead to life-threatening bleeding because this problem is difficult to diagnose and treat. This study investigated the efficacy of balloon occluded retrograde transvenous obliteration (B-RTO) to treat small intestinal variceal bleeding.

Methods: From 2003 to 2007, 6 patients with small variceal bleeding were treated by B-RTO. The characteristics of the patients, B-RTO procedures, prognosis, and occurrence of risky esophageal and gastric varices were evaluated according to their medical records.

Results: Three-dimensional (3-D) angiography by MD-CT was useful for the diagnosis of small intestinal varices and the draining vessels. In all cases, variceal bleeding was controlled by B-RTO treatment, although rebleeding was recognized in one patient after 30 months (16.6%). All patients were alive throughout the follow-up except 1 patient who died of liver failure (6-44 months). Risky esophageal varices and gastric varices occurred in 2 patients (33.3%) after B-RTO. However, no variceal bleeding occurred.

Conclusion: B-RTO was found to be an effective treatment modality which provided good initial hemostasis, thereby eradicating ectopic small intestinal varices.

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