Gastroduodenal varices remain a problematic condition due to the threat of rupture and bleeding and to their association with massive portosystemic shunting and potential hepatic encephalopathy. The efficacy of transjugular intrahepatic portosystemic shunts (TIPS) is limited in this indication. Balloon-occluded retrograde transvenous obliteration (BRTO) [1, 2] or dual balloon occlusion embolotherapy (DBOE) [3] have become attractive alternatives that can play an important role in the treatment of gastric varices, in addition to endoscopic, surgical, or other endovascular therapies. To perform BRTO, the left renal vein...

Clinical Setting, Patients and BRTO procedures This prospective, cohort study was approved by our local institutional review board and included all consecutive patients with gastric varices (Fig. 1A) undergoing BRTO at a single academic hospital. Twenty consecutive patients (Table 1, mean age = 62.4 years, range 31-81, 9 males and 11 females) with gastric varices were included in the study cohort between July 2005 and November 2008. At first the portosystemic collaterals were assessed using multislice (MS) computed tomography (CT) (Sensation Cardiac, Siemens, Erlangen, Germany)...

In four (cases 7, 10, 12, 20) of twenty patientsin whom conventional arterioportography could not demonstrate the efferent vessels of the varices (Fig. 2B), the catheter tip was intentionally displaced from the superior mesenteric artery into the celiac trunk, and a celiac FACT-AP was performed and revealed the gastrorenal shunt and the gastric varices projecting into the gastric lumen (Fig. 2C). BOAV and BOAV-FACT were performed twenty eight times totally (Table2). The results of the Wilcoxon signed rank test revealed that the diagnostic confidence level...

Rupture of esophagogastric varices is one of the most severe complications for patients with portal hypertension (approximately 30% prevalence) [8-10], with rupture of gastric varices resulting in a 45%–55% mortality rate [8-11]. Therefore, in addition to urgent and elective treatment, prophylactic obliteration of high-risk large fundic varices has been recommended [12]. However, the optimal method for treatment of gastric varices has not yet been determined and remains controversial, while endoscopic variceal ligation (EVL) [13] and endoscopic injection sclerotherapy (EIS) [14], which have become the treatments...

1) 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. 11(1):51-8, 1996. 2) Hirota S, Matsumoto S, Tomita M, Sako M, Kono M. Retrograde transvenous obliteration of gastric varices. Radiology 211: 349–356, 1999. 3) Nishida N, Ninoi T, Kitayama T, Yamamoto A, Sakai Y, Sato K, Hamuro M, Nakamura K, Inoue Y, Yamada R. Dual balloon-occluded retrograde transvenous obliteration of gastric varix draining into the left adrenal vein and...

Correspondence to Jun Koizumi, MD, PhD Department of Diagnostic Radiology, School of Medicine, Tokai University 143 Shimokasuyai, Isehara-city, Kanagawa-prefecture, 259-1193, JAPAN Phone; +81-463-93-1121, Fax; +81-463-93-6827 E-mail; [email protected]