8:56 AM Abstract No. 124 - Effects of high viscosity and conventional sclerosants on complication rates and MELD in BRTO

Abstract

Purpose 10% Ethanolamine oleate is the international standard sclerosing agent in balloon-occluded retrograde transvenous obliteration (BRTO) but its lack of availability in this concentration limits its use in the US. Our goal is to describe our initial experience, complication rates and effects on liver function utilizing high viscosity sclerosant (HVS) mixture versus conventional sclerosant. Materials and Methods We performed a retrospective analysis of nine patients in which successful BRTO was performed in the setting of acute endoscopicaly proven bleeding isolated gastric varices (IGV) from 11/10 - 9/12. The primary sclerosant used was 3% STS+Gel foam+ IV contrast solidified to a honey consistency, other sclerosants used were absolute alcohol and STS + Ethiodol (ETL). Results We performed 12 successful BRTO procedures; three were treated with absolute alcohol (ETOH), two with STS+etl and four patients treated with HVS. There were 3-grade (G) 1, 2 -G2, 3-G3 and 1- G4. Technical success rate (complete obliteration of GV) was 9 of 9 (100%). Initial clinical success rate (absence of re-bleeding in 7 days) was 100% (9/9). There were no cases of recurrent variceal bleeding requiring either TIPS or surgical intervention with a mean clinical follow-up period of 1.8 months (range, 2 to 20 weeks). Complications occurred in 3 of 9 (33%) patients; 1 death (ETOH) and 2 non target embolizations (ETOH and sts+etl) with subsequent venous thrombosis complications. No complications were associated with the HVS. Mean cohort pre-MELD (prm), post-Meld (next day follow up) (pom) and intermediate term follow-up MELD (ITFM) (mean: 1.8 mo): 14, 15.5 and 12.3. Mean prm, pom and itfm (ETOH): 16, 17 and 12. Mean prm, pom and itfm (sts+etl): 10.7, 10.1 and 8. Mean prm, pom and itfm (HVS): 14, 17 and14.5. The percentage improved MELD with ETOH, sts+etl and HVS: 29.3, 20.5 and 15.3 utilizing the fischer exact test and student t test trend of MELD over time is highly correlative (R=0.9 and p Conclusion HVS while not as a robust hepatoprotective sclerosant, in the short term appears to be effective in short term variceal obliteration with low complication rates.