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. 2022 Jun 16;5(3):138-142.
doi: 10.1016/j.jimed.2022.06.002. eCollection 2022 Aug.

Balloon-occluded retrograde transvenous obliteration with lauromacrogol sclerosant foam for gastric varices

Zhiyang Wu  1   2 , Wei Wu  3 , Cheng Tao  4 , Qin Liu  1   2 , Wenchang Li  1   2 , Qinbing Wang  1   2 , Wei Huang  1   2 , Junwei Gu  1   2 , Xiaoyan Fei  1   2 , Zhongmin Wang  1   2 , Xiaoyi Ding  1   2
Affiliations

Balloon-occluded retrograde transvenous obliteration with lauromacrogol sclerosant foam for gastric varices

Zhiyang Wu et al. J Interv Med. .

Abstract

Objectives: To evaluate the safety and efficacy of balloon-occluded retrograde transvenous obliteration (BRTO) using lauromacrogol sclerosant foam for gastric varices (GVs) with gastrorenal venous shunts.

Methods: Data of GV patients treated with BRTO using lauromacrogol sclerosant foam in 2016-2020 were retrospectively analyzed along with procedural success rate, complications, and follow-up efficacy.

Results: A total of 31 patients were treated with BRTO. The sclerosant foam was prepared by mixing iodinated oil, lauromacrogol, and air at a 1:2:3 ratio. The BRTO procedure was successfully completed in 93.5% of patients. One patient was allergic to the lauromacrogol injection. A mild postoperative fever occurred in three patients. One patient experienced grand mal seizures after the procedure. There was no significant difference in the median Child-Turcotte-Pugh scores before versus after BRTO. Complete GV resolution was observed in 93.1% of patients. One patient underwent endoscopic treatment for the development of high-risk esophageal varices. Another patient underwent transjugular intrahepatic portosystemic shunt placement for the aggravation of ascites.

Conclusions: Lauromacrogol sclerosant foam is safe and effective in patients undergoing BRTO for GV.

Keywords: Balloon-occluded retrograde transvenous obliteration; Gastric varices; Gastrorenal shunt; Sclerotherapy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A 40-year-old man presented with hepatitis B cirrhosis and upper gastrointestinal bleeding. A. Enhanced abdominal computed tomography (CT) performed prior to balloon-occluded retrograde transvenous obliteration (BRTO) demonstrated isolated gastric varices in the stomach fundus (black star). B. Endoscopy performed before BRTO showed large isolated gastric varices at the fundus (black star). Red whale signs (black arrow) were visible on the varices, indicating a high risk of bleeding. C. The collateral vessels were embolized with microcoils (black arrow). D. Fluoroscopic image showing that the gastrorenal shunt was occluded by a Fogarty balloon catheter (black arrow) and the varices filled with sclerosant foam (black arrowheads). E. Enhanced CT performed 1 year after BRTO showing complete variceal regression. F. Endoscopy performed 2 years after BRTO showing nearly complete variceal regression with a few small emerging collaterals.
Fig. 2
Fig. 2
Changes in hepatic function. Child-Turcotte-Pugh scores before and 1, 3, and 6 months after BRTO were 6.5 ​± ​1.3, 7.0 ​± ​2.0, 6.4 ​± ​1.6, and 6.0 ​± ​1.1, respectively. The change was insignificant (p ​= ​0.54).
See this image and copyright information in PMC

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