Usefulness of antegrade foam sclerotherapy for portal hypertensive variceal bleeding

Abstract

Purpose: This study investigates the usefulness of antegrade variceal embolization using sclerosant foam to evaluate technical success and clinical outcomes in cases of hypertensive variceal bleeding.

Methods: A total of 16 patients underwent percutaneous antegrade variceal embolization using foam sclerotherapy from August 2019 to January 2022. Among the patients, 12 cases were of gastroesophageal varices, two were rectal varices, and one case each was duodenal and jejunal varices, respectively. Sodium tetradecyl sulfate (STS) foam was used as a detergent for variceal bleeding sclerotherapy at various anatomical locations. The detergent was used in a foam form to promote clinical outcomes and enable the effective embolization of the entire blood vessel wall, including the ventral side, against gravity. Furthermore, STS foam could be used to help sufficiently deliver the drug to distal segments. A balloon catheter was also used to block the antegrade flow and prevent the dilution of the sclerosant. Technical success was defined as the completion of sclerotherapy for variceal bleeding as planned before the procedure to achieve the disappearance of variceal bleeding. Clinical success was defined as the complete obliteration of varices without recurrent bleeding during the follow-up period after the procedure.

Results: Technical success was 81.3%, and clinical success was 84.6%. Additionally, 15/16 of the procedures were emergencies, and there were no complications related to the procedure.

Conclusion: Antegrade foam sclerotherapy using 3% STS for variceal bleeding is clinically safe and effective. Moreover, antegrade foam sclerotherapy can be a useful treatment option for patients with active variceal bleeding in emergency cases.

Keywords: Portal hypertension; foam sclerotherapy; percutaneous endovascular variceal embolization; variceal bleeding.

Figure 1

A 52-year-old man with gastroesophageal varices. (a) Endoscopy shows marked engorged gastroesophageal varices, grade GII (red color sign). (b) Antegrade venography through a transportal approach shows multiple gastric and esophageal varices (black arrow). Two branching vessels (white arrow) are denoted as feeding vessels to the varices. (c) Multiple varices (black arrow) are filled with foam sclerosant (3% sodium tetradecyl sulfate) under inflation by the balloon catheter (4Fr Fogarty catheter) (white arrow) at the coronary vein ostium. (d) Follow-up splenoportography after completing sclerotherapy shows the complete obliteration of previously noted gastric and esophageal varices. (e) Follow-up endoscopy nine days after percutaneous antegrade varix obliteration showing the complete thrombotic occlusion of a previously engorged varix with no red color.