Balloon-Occluded Retrograde Transvenous Obliteration of Jejunal Varices: A Case Report, Therapeutic Approach

Abstract

Jejunal varices occur very rarely [1–5]. Moreover, unlike esophageal or gastric varices, they are difficult to treat with an endoscopic approach because of their anatomic location. While surgery is an option, it is invasive and risky, especially in patients with liver cirrhosis and poor hepatic function. Thus, endovascular intervention may be a better approach for jejunal varices. The endovascular treatments for gastric varices include balloon-occluded retrograde transvenous obliteration (BRTO), percutaneous transhepatic obliteration, and transjugular intrahepatic portosystemic shunt (TIPS). TIPS reduces portal pressure by diverting portal flow to a hepatic vein through an artificial shunt, thereby reducing variceal hypertension and risk of bleeding, but can worsen liver function and cause hepatic encephalopathy. In contrast, BRTO directly induces sclerosis of the varices. Therefore, hepatic encephalopathy is not associated with this procedure. BRTO also associates with a lower rate of variceal bleeding recurrence than TIPS [6, 7]. For these reasons, BRTO is currently considered to be the first endovascular treatment choice for gastric varices. BRTO is a minimal invasive radiologic procedure that gives the sclerosing agent while blocking the outflow by a balloon catheter [8]. This report describes a case of jejunal varices treated with BRTO.