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Safety and Efficacy of Sodium Tetradecyl Sulfate and Lipiodol Foam in Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for Large Porto-Systemic Shunts

  • Clinical Investigation
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Abstract

Objective

To evaluate the safety and efficacy sodium tetradecyl sulfate and lipiodol foam (STS foam) in BRTO for large (caliber ≥15 mm) porto-systemic shunt and gastric fundal varices.

Materials and Methods

It is a retrospective record-based study of patients who underwent BRTO using STS foam at the Institute of Liver and Biliary Sciences, New Delhi, for gastric variceal bleed or refractory hepatic encephalopathy (HE) who had large porto-systemic shunt (diameter ≥15 mm) with or without associated gastric varices. Clinical and laboratory parameters were evaluated before and after the procedure. All patients were followed for minimum of 12 months.

Results

Records of 22 patients were analyzed. Technical success was achieved in 22 of 22 sessions. Complete obliteration of shunt with clinical improvement was seen in 20 of 22 cases. Patients with gastric varices had no residual gastric varices on follow-up endoscopy. There were significant reduction in CTP scores and improvement in HE grades following BRTO. Post-procedure complication was encountered in 6 patients (5 minor and 1 major), and 7 patients showed worsening of esophageal varices and underwent endoscopic variceal ligation. One patient had succumbed to septicemia at a follow-up of 34 months.

Conclusion

Our experience suggests STS foam is a safe and effective agent for patients with large shunt undergoing BRTO.

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References

  1. Williams SG, Westaby D. Management of variceal haemorrhage. BMJ. 1994;308:1213–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Kanagawa H, Mima S, Kouyama H, Gotoh K, Uchida T, Okuda K. Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol. 1996;11:51–8.

    Article  CAS  PubMed  Google Scholar 

  3. Ninoi T, Nakamura K, Kaminou T, et al. TIPS versus transcatheter sclerotherapy for gastric varices. AJR. 2004;183:369–76.

    Article  PubMed  Google Scholar 

  4. Hirota S, Matsumoto S, Tomita M, Sako M, Kono M. Retrograde transvenous obliteration of gastric varices. Radiology. 1999;211:349–56.

    Article  CAS  PubMed  Google Scholar 

  5. Koito K, Namieno T, Nagakawa T, Morita K. Balloon-occluded retrograde transvenous obliteration for gastric varices with gastrorenal or gastrocaval collaterals. AJR. 1996;167:1317–20.

    Article  CAS  PubMed  Google Scholar 

  6. Albanese G, Kondo KL. Pharmacology of sclerotherapy. Semin Interv Radiol. 2010;27(4):391–9.

    Article  Google Scholar 

  7. Dietzek CL. Sclerotherapy: introduction to solutions and techniques. Perspect Vasc Surg Endovasc Ther. 2007;19(3):317–24.

    Article  PubMed  Google Scholar 

  8. Vaidya S, Tozer KR, Chen J. An overview of embolic agents. Semin Interv Radiol. 2008;25(3):204–15.

    Article  Google Scholar 

  9. Sabri SS, Swee W, Turba UC, et al. Bleeding gastric varices obliteration with balloon-occluded retrograde transvenous obliteration using sodium tetradecyl sulfate foam. J Vasc Interv Radiol. 2011;22:309–16.

    Article  PubMed  Google Scholar 

  10. Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei A. Hepatic encephalopathy–definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002;35(3):716–21.

    Article  PubMed  Google Scholar 

  11. Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14:S199–202.

    Article  PubMed  Google Scholar 

  12. Gandini R, Konda D, Reale CA, et al. Male varicocele: transcatheter foam sclerotherapy with sodium tetradecyl sulfate—outcome in 244 patients. Radiology. 2008;246:612–8.

    Article  PubMed  Google Scholar 

  13. Matsumoto A, Hamamoto N, Nomura T, et al. Balloon-occluded retrograde transvenous obliteration of high-risk gastric fundal varices. Am J Gastroenterol. 1999;94:643–9.

    Article  CAS  PubMed  Google Scholar 

  14. Fukuda T, Hirota S, Sugimura K. Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy. J Vasc Interv Radiol. 2001;12:327–36.

    Article  CAS  PubMed  Google Scholar 

  15. Kato T, Uematu T, Nishigaki Y, et al. Therapeutic effect of balloon-occluded retrograde transvenous obliteration on portal-systemic encephalopathy in patients with liver cirrhosis. Intern Med. 2001;40:688–91.

    Article  CAS  PubMed  Google Scholar 

  16. Ninoi T, Nishida N, Kaminou T, et al. Balloon- occluded retrograde Transvenous obliteration of gastric varices with gastro-renal shunt: long-term follow-up in 78 patients. Am J Roentgenol. 2005;184(4):1340–6.

    Article  Google Scholar 

  17. Takashimizu S, Watanabe N, Kojima S, et al. Efficacy of balloon occluded retrograde transvenous obliteration (B-RTO) performed in a patient with primary biliary cirrhosis with severe recurrent hepatic encephalopathy due to splenorenal shunt. Tokai J Exp Clin Med. 2007;32:70–4.

    PubMed  Google Scholar 

  18. Sherif SH, Robert SS, Michael JH, et al. Reversal of hepatic encephalopathy after occlusion of total portosystemic shunts. Am J Surg. 1981;142:285–9.

    Article  Google Scholar 

  19. Hiraoka A, Kurose K, Hamada M, et al. Hepatic encephalopathy due to intrahepatic portosystemic venous shunt successfully treated by interventional radiology. Intern Med. 2005;44:212–6.

    Article  PubMed  Google Scholar 

  20. Mukund A, Rajesh S, Arora A, et al. Efficacy of balloon-occluded retrograde transvenous obliteration of large spontaneous lienorenal shunt in patients with severe recurrent hepatic encephalopathy with foam sclerotherapy: initial experience. J Vasc Interv Radiol. 2012;23:1200–6.

    Article  PubMed  Google Scholar 

  21. Akahane T, Iwasaki T, Kobayashi N, et al. Changes in liver function parameters after occlusion of gastrorenal shunts with balloon-occluded retrograde transvenous obliteration. Am J Gastroenterol. 1997;92:1026–30.

    CAS  PubMed  Google Scholar 

  22. Chikamori F, Kuniyoshi N, Shibuya S, Takase Y. Eight years of experience with transjugular retrograde obliteration for gastric varices with gastrorenal shunts. Surgery. 2001;129:414–20.

    Article  CAS  PubMed  Google Scholar 

  23. Kitamoto M, Imamura M, Kamada K, et al. Balloon-occluded retrograde transvenous obliteration of gastric fundal varices with hemorrhage. AJR. 2002;178:1167–74.

    Article  PubMed  Google Scholar 

  24. Cardoso J, Gautreau C, Jeyaraji PR, et al. Augmentation of portal blood flow improves function of human cirrhotic liver. Hepatology. 1994;19:375–80.

    Article  CAS  PubMed  Google Scholar 

  25. Miyamoto Y, Oho K, Kumamoto M, et al. Balloon-occluded retrograde transvenous obliteration improves liver function in patients with cirrhosis and portal hypertension. J Gastroenterol Hepatol. 2003;18:934–42.

    Article  PubMed  Google Scholar 

  26. Yamagami T, Kato T, Iida S, Tanaka O, Nishimura T. Change in the hemodynamics of the portal venous system after retrograde transvenous balloon occlusion of a gastrorenal shunt. AJR. 2003;181:1011–5.

    Article  PubMed  Google Scholar 

  27. Kumamoto M, Toyonaga A, Inoue H, et al. Long term results of balloon- occluded retrograde transvenous obliteration for gastric varices: hepatic deterioration links to porto-systemic shunt syndrome. J Gastroenterol Hepatol. 2010;25(6):1129–35.

    Article  PubMed  Google Scholar 

  28. Kasuga A, Mizumoto H, Matsutani S, Kobayashi A, Endo T, Ando T, et al. Portal hemodynamics and clinical outcomes of patients with gastric varices after balloon-occluded retrograde transvenous obliteration. J Hepatob Pancreat Sci. 2010;17:898–903.

    Article  Google Scholar 

  29. Akahoshi T, Hashizume M, Tomikawa M, et al. Long-term results of balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding and risky gastric varices: a 10-year experience. J Gastroenterol Hepatol. 2008;23:1702–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi, 110070, India

    Amar Mukund, Ganesh Deogaonkar & S. Rajesh

  2. Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi, 110070, India

    Saggerre Muralikrishna Shasthry & Shiv Kumar Sarin

Authors
  1. Amar Mukund
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  2. Ganesh Deogaonkar
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  3. S. Rajesh
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  4. Saggerre Muralikrishna Shasthry
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Corresponding author

Correspondence to Ganesh Deogaonkar.

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The authors declare that there is no conflict of interests.

Ethical Approval

The authors declare that all procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

The authors declare that informed consent was obtained from all individual participants included in the study prior to the procedure.

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Mukund, A., Deogaonkar, G., Rajesh, S. et al. Safety and Efficacy of Sodium Tetradecyl Sulfate and Lipiodol Foam in Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for Large Porto-Systemic Shunts. Cardiovasc Intervent Radiol 40, 1010–1016 (2017). https://doi.org/10.1007/s00270-017-1593-5

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  • DOI: https://doi.org/10.1007/s00270-017-1593-5

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