Endoscopic Embolization Research Articles

Endoscopic embolization of a refractory bronchobiliary fistula by endoscopic retrograde cholangiography using coils and Histoacryl.

Endoscopic embolization of a refractory bronchobiliary fistula by endoscopic retrograde cholangiography using coils and Histoacryl.

An Unusual Cause of Portal Hypertension

Question: A 49-year-old woman presented to our hospital with nausea, vomiting, and abdominal distension for more than 10 days, accompanied by diarrhea for 3 days. She reported no history of drinking, viral hepatitis, liver cirrhosis, tuberculosis, autoimmune diseases, genetic metabolic diseases, abdominal surgery, or trauma. Four years earlier, she had developed moderately severe acute pancreatitis with partial necrosis of the head and neck of the pancreas. It was further complicated by superior mesenteric vein thrombosis without organ failure, and she was hospitalized for 19 days. Physical examination revealed a distended abdomen with positive shifting dullness. Hepatic facies, spider angiomas, and abdominal wall varices were absent. Her laboratory tests revealed a white blood cell count of 5.56 × 109/L, a platelet count of 150 × 109/L, and a hemoglobin level of 10.5 g/dL. Liver tests revealed an albumin level of 37.77 g/L, total bilirubin level of 1.3 mg/dL, and an aspartate transaminase level of 24.6 U/L. Ascites fluid analysis test revealed a white blood cell count of 85 × 106/L, red blood cell count of 60 × 106/L, and serum ascites albumen gradient (SAAG) >1.1 g/dL. Contrast-enhanced computed tomography (CT) revealed portal hypertension, collateral circulation, portal vein thrombosis, splenomegaly, and massive ascites. During the arterial phase of CT, the portal vein (Figure A) and superior mesenteric vein (Figure B) were visible, and several branch vessels surrounded the superior mesenteric vein. The liver size and shape were normal. Hematemesis occurred during hospitalization, and endoscopy revealed mild esophageal varices as well as ruptured and bleeding gastric varices. Endoscopic embolization of gastric varices was performed. The variceal region was injected with a mixture of N-butyl 2-cyanoacrylate and 50% glucose solution.

Endoscopic embolization of a refractory bronchobiliary fistula by endoscopic retrograde cholangiography using coils and Histoacryl.

Endoscopic embolization of a refractory bronchobiliary fistula by endoscopic retrograde cholangiography using coils and Histoacryl.

A119 ACUTE DIVERTICULITIS & CONCURRENT DIVERTICULAR BLEED: A RARE CLINICAL ENTITY

AimsColonic diverticula are mostly asymptomatic incidental findings on cross sectional imaging or colonoscopy. In the setting of known diverticulosis, complications like diverticulitis and diverticular bleeding occur in only 4% and 1% of patients respectively. It is unusual to see both complications expressed in the same patient and moreover, rare to see them expressed concurrently. We report a case of concurrent diverticulitis with diverticular bleed and expand on the clinical course.MethodsCase reportResultsA 73-year old was diagnosed with sigmoid diverticulitis based on her clinical presentation and an abdominal CT scan. She was discharged home on oral antibiotics but presented a week later with painless rectal bleeding. In view of the ongoing diverticulitis, a colonoscopy was not pursued although it is the typical procedure of choice to manage active gastrointestinal bleeding. A CT scan was recommended as the alternate initial investigation, which revealed active colonic bleeding in the region of the hepatic flexure immediately adjacent to a diverticulum. A subsequent CT angiogram identified the middle colic artery to be the responsible blood supply to the region and embolization coils were deployed within this vessel in an attempt to achieve hemostasis.Despite vascular intervention the patient continued to bleed and resuscitation with blood products was insufficient. A repeat CT scan ruled out any areas of colonic ischemia as well as any further active areas of extravasation. A decision was made to proceed with a total colectomy to provide definitive treatment of the diverticular disease and manage the bleeding. An urgent intraoperative colonoscopy was attempted but quickly abandoned due to suboptimal preparation and ongoing bleeding obscuring the view. The patient underwent a total colectomy with ileorectal anastomosis. On pathology there was extensive diverticulosis of the ascending and the sigmoid colon with diverticulitis and diverticular abscess cavities within the sigmoid colon.ConclusionsDiverticulitis and diverticular bleed are thought to be unrelated complications of diverticulosis involving distinct physiologic pathways (Figure 1). Although diverticular bleed may occur in patients with a history of prior diverticulitis, concurrent presentation of these two entities is extremely rare. In addition, diverticular bleed is mostly self-limiting. While endoscopic and vascular embolization are established treatment options, colectomy is rare for the management of diverticular bleeding.We report a rare case of concurrent diverticulitis and lower GI bleeding. The presence of the sigmoid diverticulitis made interventional radiology a relatively safer option over endoscopy, which is the typical first line diagnostic and interventional procedure. Ongoing bleeding led to total colectomy and provided the patient with a definitive cure for her diverticular disease. Funding AgenciesNone

N-butyl-2-cyanoacrylate renal stone, a rare complication after embolization of urinary fistula: A case report

Embolization with N-butyl-2-cyanoacrylate (NBCA) is an effective and safe procedure recently used for closure of upper tract urinary fistula. However, NBCA constitutes a foreign body for human organs, so it can cause complications. In our case a 56-year-old man underwent an endoscopic embolization of urinary fistula with NBCA. Six years later an UroCT scan revealed a large lithiasis of the left kidney, treated with endoscopic and percutaneous surgery. Stone analysis revealed a composition of crystals mixed with cyanoacrylate. In our opinion this example of complication after NBCA use for endoscopic procedures, rarely reported in literature, can be an useful advisement to reconsider the use of this glue. Keywords: N-butyl-2-cyanoacrylate; gluestone; percutaneous; endoscopic; fistula

Embolization for acute gastrointestinal bleeding

Purpose: To retrospectively evaluate the clinical success and complication rates following interventional embolization for treatment of acute gastrointestinal bleeding (GIB) at a tertiary care centre. The secondary purpose was to evaluate results of practice change whereby multiphase CT angiography was requested prior to conventional angiograms.
 Methods: A retrospective chart review and analysis of 38 patients undergoing Interventional Radiology guided embolization for acute GIB was performed. Clinical success was defined as patient stability 30 days’ post embolization and complications included subsequent bleeding requiring endoscopy, surgery or additional embolization, or death.
 Results: Overall clinical success rate was 86.8% (33/38). Complications included 14 patients (36.8%) experiencing continued bleeding, 6 patients (15.8%) requiring repeat endoscopic evaluation, 8 patients (21.1%) requiring surgery, 3 patients (7.9%) requiring repeat embolization, and 4 deaths (10.5%). These results were not inferior to clinical success rates reported in the literature for GIB regardless of location. Positive predictive value for multiphase CT angiogram was 92.3% and the negative predictive value was 57.1%.
 Conclusions: Interventional angiography and embolization is an effective treatment for GIB with the most common complication being recurrent bleeding which may require additional endoscopic evaluation, surgical intervention or additional embolization. Clinical success and complication rates at this centre are similar to those reported in the literature. Continued evaluation of the utility of multiphase CT angiography prior to conducting embolization should be considered to determine its impact on rates of negative angiogram studies.

2386 Shock Liver: A Complication of Gastroduodenal Artery Embolization

INTRODUCTION: PUD is the most common cause of acute upper GI bleeding. Duodenal ulcers are 4x more likely to bleed than gastric ulcers. Posterior duodenal ulcers, are more likely to erode into the gastroduodenal artery (GDA) resulting in massive bleeding requiring intervention. Liver failure is a known complication of gastroduodenal artery embolization due to inadvertent embolization of the main hepatic artery [1,2]. CASE DESCRIPTION/METHODS: A 71 year old lady presented with a hemoglobin of 5.7 g/dL with a baseline of 10.7 g/dL. She was resuscitated with pRBCs and fluids to a hemoglobin of 8.7 g/dL. EGD showed an active 3 cm bleeding ulcer at the duodenal bulb with a visible vessel and adherent clot. Hemostasis was achieved with epinephrine, two hemoclips and gold probe cautery. On POD# 5, she had two melenic stools and an acute drop in hemoglobin reaching a nadir of 6.4 g/dL which prompted a repeat EGD. An ulcerated area on the posterior wall of the bulb was bleeding, hemostasis with epinephrine and three hemoclip deployment failed. Subsequently, she underwent gastroduodenal artery coiling. During the embolization, the coil was partially protruding into the hepatic artery. Coil repositioning failed. POD# 1, AST and ALT trended up to 2814 IU/L and 1375 IU/L from a baseline of 14 IU/L and 10 IU/L on admission, respectively. INR trended up from 1.23 to 1.8, she developed encephalopathy, was diagnosed with shock liver and transferred to outside liver transplant center. DISCUSSION: Technical success rates of transcatheter arterial embolization are extremely high (>90%) while clinical success rates vary from 60%-90% [3]. This difference may be attributed to multiorgan failure, coagulopathy, and bleeding from trauma or invasive procedures [4]. A lack of understanding of the factors that influence clinical outcome also plays a role. Transcatheter therapeutic embolization has a very high rate of success and should be considered as an alternative to surgery in high-risk populations. [1,2]. Endoscopic embolization usually has a low rate of complications of rebleeding, infarction, and rarely coil migration [3,5,]. Coil migration has been described after embolization of the GDA, but infrequently been reported to be fatal. Our patient had movement of the sheath used to protect the hepatic artery and the catheter resulting in partial migration of the coils into the hepatic artery which led to shock liver. To our knowledge, few cases of coil migration inducing hepatic failure have been reported in the literature.

Endoscopic Coil as a Foreign Body in the Maxillary Sinus: A Complication of Endoscopic Embolization for Epistaxis

Endoscopic Coil as a Foreign Body in the Maxillary Sinus: A Complication of Endoscopic Embolization for Epistaxis

Non-operative management of blunt hepatic injury: Early return to function, chemical prophylaxis, and elucidation of Grade III injuries

Background: Selective non-operative management of blunt hepatic trauma has shown decreased mortality and iatrogenic injury. Evidence-based recommendations are difficult to obtain regarding management of Grade III hepatic injuries and safe timing to implement return to function measures (enteral intake, chemical deep vein thrombosis [DVT] prophylaxis, and ambulation). Materials and Methods: This is a prospective, observational study of 130 trauma patients with blunt hepatic injuries over 2 years. A guideline was utilized to emphasize early hepatobiliary iminodiacetic acid scan and return to function measures at 24 h after injury. Patients were treated non-operatively with endoscopic retrograde cholangiopancreatography, percutaneous drainage, or embolization per evidence-based guidelines. Results: Fifty-seven patients suffered Grade III–V blunt liver injury. The biliary leak rate was higher for Grade IV and V liver injuries than Grade III (48%, 43%, and 12%, respectively) compared to lower grade injuries (0%). There was no significant difference in complications from initiation of chemical DVT prophylaxis, ambulation, or early enteral intake as a function of grade of hepatic injury. The average time to progression of treatment was 24 h and independent of the grade of liver injury. High-grade liver injuries were associated with lower age, increased injury severity score, and increased Intensive Care Unit length of stay. Conclusions: Trauma providers should consider Grade III liver injuries as low-grade injuries and treat accordingly. However, Grade IV and V injuries fail non-operative management more often than other grade injuries. Early enteral nutrition, chemical DVT prophylaxis, and ambulation are safe regardless of the grade of hepatic injury. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement, Systems-based practice.

Non-traumatic superior hypophyseal aneurysm with associated pseudoaneurysm presenting with massive epistaxis

Although a common medical problem, epistaxis rarely requires eurosurgical intervention. Bleeding most commonly occurs from iesselbach’s plexus in the anterior septal area and usually resolves ith manual compression, vasoconstrictors, or simple nasal packng. Epistaxis from the posterior nasal cavity is more difficult to anage and if not resolved with conservative measures, sometimes equires endoscopic cauterization or endovascular embolization of he internal maxillary artery (IMA). Rare neurosurgical causes of pistaxis include traumatic and infectious pseudoaneurysms, cavrnous aneurysms, sellar tumors, and dural arteriovenous fistulas. The first case of massive epistaxis caused by an intracranial neurysm was published at a lecture at the Royal College of Sureons of England by Dr. Beadles in 1907 [1]. Since then, there ave been several reports of severe epistaxis from aneurysms r pseudoaneurysms eroding into the paranasal sinuses [2]. The ajority of these reports are extradural pseudoaneurysms of the C4 egment secondary to severe head trauma, particularly with fracures of the skull base [2]. Although extremely rare, non-traumatic neurysms or pseudoaneurysms causing massive epistaxis have lso been reported in the literature. Again, these are generally xtradural aneurysms most commonly of the C4 segment. Known auses include radiation, infection, and aneurysms associated with umors.

Endoscopic embolization with onyx prior to resection of JNA: A new approach

Objective To report a novel pioneering approach of endoscopic embolization (EE) and resection of juvenile nasopharyngeal angiofibroma (JNA) and describe all outcomes and results. Methods Four patients presented to the University of Miami with repeated episodes of unilateral epistaxis diagnosed by fiberoptic and radiographic examination as nasal JNA. Subsequently, in conjunction with neurosurgery, endoscopic visualization was provided to perform intratumor needle insertion, through which the liquid embolic agent Onyx was infused to embolize the JNA's under fluoroscopic and endoscopic guidance. The day after EE, endoscopic resection was performed. Operating room time, estimated blood loss (EBL), and other intraoperative and post-operative results are reported and compared to published literature. Results A total of 4 patients (all males), had EE of JNA and subsequent endoscopic resection between September 2008 and January 2009. Average EBL during surgery was 412.5 ml (range 150–800) with an average operating room time of 228 min (range 95–485). We experienced no bleeding from the tumor or its attachments, only from the approach. Two patients experienced mild numbness in the V2 distribution, which began to resolve one week post-operatively. No other complications were encountered. Conclusions This is the first published report of direct endoscopic embolization of JNA with Onyx. Although further studies are needed, it seems to provide a safe, less invasive alternative to traditional embolization and endoscopic resection, but must be done in cooperation with interventional neurosurgery to maximize its safety profile.

Endoscopic embolization and resection of JNA: A new approach

Endoscopic embolization and resection of JNA: A new approach

Endoscopic embolization combined with variceal ligation in the treatment of gastroesophageal variceal bleeding

Objective To explore the therapeutic effect of combined endoscopic embolization and variceal ligation （EVL） for management in cirrhotic patients with gastroesophageal varieeal bleeding. Methods One hundred and fifty-six cases of active gastric fundal variceal bleeding combined with esophageal varices of over degree Ⅱ , and with other causes leading to upper digestive tract bleeding excluded, were randomized into therapeutic group （ n = 80） and control group （ n = 76）. For the therapeutic group, endoscopic eyanoacrylate injection for embolization of gastric fundal varices and EVL for esophageal varices were performed simultaneously. For the control group, EVL was performed 2 months after embolization. Results There was no complication in both groups. The rate of hemostasis in therapy group was 96. 3% （77/80） , and that in control group was 97.4% （ 74/76, P 〉 0. 05 ）. There was significant difference between two groups, regarding the rates of early re-bleeding [ 6. 4% （ 5/78 ） vs 21.3% （ 16/75 ） , P 〈 0. 05 ] and rebleeding at 6 months [ 13.0% （9/69） vs 25.4% （ 17/67）, P 〈0. 05]. There was no significant difference between two groups, regarding the effective rate in disappearance of gastric fundus varices （61.6% vs 59. 1% ）, and in that of esophageal varices （74. 0% vs 67. 9% ）. Conclusion Endoscopic embolization of gastric fundus varices, combined with EVL for esophageal varices, is a safe and effective procedure for the treatment of gastroesophageal variceal bleeding, and it can reduce the rate of re-bleeding. Key words: Esophageal and gastric varices ; Embolization, theraputic ; Ligation ; Endoscopy

Duodenoportal fistula caused by peptic ulcer after extended right hepatectomy for hilar cholangiocarcinoma

BackgroundA fistula between the duodenum and the main portal vein near a peptic ulcer is extremely rare, and only two cases of duodenal ulcers have been reported in the past.Case presentationWe report a 68-year-old man with a diagnosis of anemia who had a history of extended right hepatectomy for hilar cholangiocarcinoma 20 months previously. The first endoscopic examination revealed a giant peptic ulcer with active bleeding at the posterior wall of the duodenal bulbs, and hemostasis was performed. Endoscopic treatment and transarterial embolization were performed repeatedly because of uncontrollable bleeding from the duodenal ulcer. Nevertheless, he died of sudden massive hematemesis on the 20th hospital day. At autopsy, communication with the main portal vein and duodenal ulcer was observed.ConclusionIt should be borne in mind that the main portal vein is exposed at the front of the hepatoduodenal ligament in cases with previous extrahepatic bile duct resection.

An anatomical classification of the variations of the inferior phrenic vein

The majority of anatomical textbooks of gross anatomy offer very little information concerning the anatomy and distribution of the inferior phrenic vein (IPV). However, in the last decade, an increasing number of reports have arisen, with reference to the endoscopic embolization of esophageal and paraesophageal varices, as well as venous drainage of hepatocellular carcinomas (HCC). The IPV is one of the major sources of collateral venous drainage in portal hypertension and HCC. The aim of this study was to identify the origin and distribution of the IPVs (right and left), both in normal and (selective) pathological cases. We have examined 300 formalin-fixed adult cadavers, without any visible gastrointestinal disease, and 30 cadavers derived from patients with HCC. The right IPV drained into the following: the inferior vena cava (IVC) inferior to the diaphragm in 90%, the right hepatic vein in 8%, and the IVC superior to the diaphragm in 2%. The left IPV drained into the following: the IVC inferior to the diaphragm in 37%, the left suprarenal vein in 25%, the left renal vein in 15%, the left hepatic vein in 14%, and both the IVC and the left adrenal vein in 1% of the specimens. The IPVs possessed four notable tributaries: anterior, esophageal, lateral and medial. The right IPV served as one of the major extrahepatic draining veins for all 30 cases of HCC. These findings could have potential clinical implications in the transcatheter embolization of esophageal and paraesophageal varices, as well as in mobilizing the supradiaphragmatic segment of IVC.

Correlation between Endoscopic and Angiographic Findings in Patients with Esophageal and Isolated Gastric Varices

Background/Aim: The correlation between angiographic vascular patterns and endoscopic findings in portal hypertension is not sufficiently known, and knowledge of the vascular anatomy may contribute to an improvement in endoscopic embolization and transjugular retrograde obliteration procedures. We propose a new vascular map that should prove useful for this purpose. Methods: Between April 1985 and December 1997 we performed percutaneous transhepatic portography in a selected group of 75 patients (16 women and 59 men), aged 43–71 years, from whom informed consent was obtained. All patients had been diagnosed endoscopically as having either esophageal or isolated gastric varices. According to the Child-Pugh classification, class A, B, and C cirrhosis was seen in 19, 40, and 16 patients, respectively. We created a vascular map of esophageal and isolated gastric varices, based on the opacification of the portal venous collaterals on percutaneous transhepatic portography. We compared the patients in both variceal groups in terms of portal venous pressure, main blood supply, and drainage routes. Results: We found that the portal collateral system was divided into two systems: the portoazygos venous system and the portophrenic venous system. The former contributed to the formation of esophageal and cardiac varices and the latter to the formation of isolated gastric varices located at the fundus or at both the cardia and fundus. The left gastric vein participated as blood supply in 70% of the isolated gastric varices and in 100% of the esophageal varices (p < 0.01). The posterior gastric vein participated as blood supply in 70% of the isolated gastric varices and in 24% of the esophageal varices (p < 0.01). We classified the main blood drainage routes of isolated gastric varices functionally into three types: gastrorenal shunt (85%), gastrophrenic shunt (10%), and gastropericardiac shunt (5%). The portal venous pressure in patients with esophageal varices was 358 ± 66 mm H₂O, whereas in patients with isolated gastric varices it was 262 ± 44 mm H₂O (p < 0.01). Conclusion: We suggest that this new vascular map will be useful in endoscopic embolization and transjugular retrograde obliteration procedures for esophageal and isolated gastric varices.

Short-Term Portal Hemodynamic Effects of Endoscopic Embolization for Esophageal Varices

Background/Aim: Endoscopic embolization (EE) is a specialized treatment that obliterates esophageal varices along with their associated blood supply. The purpose of this study was to investigate the short-term effects of EE for esophageal varices on portal hemodynamics and liver function. Methods: Thirty patients with esophageal varices were included in this study. The portal blood flow was measured by an ultrasonic duplex Doppler system before and after EE. EE was performed by freehand intravariceal injection of 5% ethanolamine oleate with iopamidol with the aid of a balloon attached to the tip of an endoscope under fluoroscopy. Results: For the blood supply system, endoscopic varicography at the time of EE was able to show the vessels of the cardiac branch of the left gastric vein in 93% of the cases, the cardiac venous plexus in 90%, the trunk of the left gastric vein in 27%, the lesser curvature branch of the left gastric vein in 10%, the fundic branch of the short gastric vein in 13%, and the posterior gastric vein in 13%. For the blood drainage system, endoscopic varicography was able to show the paraesophageal vein in 39% of the cases, the inferior phrenic vein in 17%, and the mediastinal vein in 13%. No clotting was detected after EE in the intra- and extraportal veins in any of the cases. The flow velocities in the main portal vein before and after EE were 14.2 ± 3.2 and 15.5 ± 3.5 cm/s, respectively, showing no significant change. The cross-sectional area of the portal vein before and after EE was 0.96 ± 0.21 and 1.04 ± 0.23 cm², and the flow volume of the portal vein was 817 ± 288 and 930 ± 189 ml/min, both also showing no significant change. The blood laboratory parameters showed no significant change after EE. Conclusions: We conclude that neither portal blood flow nor liver function were damaged by EE, although both the varices and their associated blood supply were obliterated.

Reversal of Portosystemic Encephalopathy after Endoscopic Embolization of Recurrent Gastroesophageal Varices

Abstract:Chronic portosystemic encephalopathy (CPSE) due to a shunt via gastroesophageal varices is uncommon. We were able to control a case of CPSE due to recurrent gastroesophageal varices using endoscopic embolization (EE). A 68‐year‐old man presented at our hospital in a confused, apathetic and tremulous state. He had undergone devascularization, proximal gastric transection and splenectomy for esopha‐geal varices due to liver cirrhosis 16 years previously. The patient had hyperammone‐mia (228 µg/dl), and endoscopic examination revealed nodular cardiac varices and large recurrent esophageal varices. Superior mesenteric arterial portography revealed that a large volume of superior mesenteric venous blood drained into the cardiac and esophageal varices through the remnant left gastric vein. The plasma ammonia level in the esophageal varices taken at the time of EE was 419 pg/dl, which was a much higher level than that of peripheral vessels, the superior vena cava and azygos vein, and suggested that the encephalopathy was due to the portosystemic shunt via the gastroesophageal varices. EE was performed using 5% ethanolamine oleate with iopamidol under fluoroscopy. The esophageal and cardiac varices were successfully embolized, the CPSE disappeared, and the plasma ammonia level decreased to 27 pg/dl. No complications were observed, and the patient was discharged on day 37 after EE. We conclude that EE is an effective and safe treatment for CPSE due to gastroesophageal varices.

A CASE OF DUODENAL VARICES

A case of duodenal varices successfully treated by a systemic obliteration of the varices, which has been employed at the department, is reported with a review of the Japanese literature. A 52-year-old woman was admitted to the hospital because of tarry stool. An upper gastrointestinal endoscopy showed an enlarged and tortuous varices with redness in the second portion of the duodenum. Transileocolic vein portgraphy revealed collateral veins composed of the supperior and inferior pancreaticoduodenal veins. From these findings a diagnosis of duodenal varices was made, and a systemic obliteration of varices which composed of an embolization by coils and endoscopic embolization was performed. After that, endoscopical examination revealed that morphology of the varices was improved but the redness persisted. Endoscopic obliteration was carried out two times. No recurrence of the varices has been observed during the follow up period of two years after the treatment. Duodenal varix is rare and the etiology mainly attributable to portal hypertension. It can cause gastrointestinal bleeding. A systemic obliteration of the collateral veins, which has been employed for esophageal varices at the department, was useful.

食道静脈りゅう硬化療法用薬剤に関する研究 第３報 オルダミン注射用と各種造影剤との配合変化試験

Ethanolamine oleate (EO) injection containing a contrast medium has been used as an agent for sclerosing treatment (endoscopic embolization) of esophageal varix.We tested the compatibility of 10% ethanolamine oleate injection [Oldamin for Injection (OD)] with 3 kinds of contrast media [Iopamiron 300 (IP300), Omnipaque 300 (0P300), Isovist 240 (IV240)] and water for injection.The sterilized samples were stored for three months at 6° and 25°, and the unsterilized samples for a week at 25° and 40°.The changes in appearance, pH, viscosity, osmotic pressure, and contents of the contrast medium, oleic acid and benzyl alcohol, and the concentration of iodide (contaminant) were examined at intervals.In all samples, no significant changes were observed in each test item except the concentration of iodide and appearance. After sterilization, OD-0P300 showed the highest concentration of iodide (206μg/ml, while ODIP300 and OD-IV240 showed 36μg/ml and 105μg/ml, respectively) and yellow coloration.The concentration of iodide in OD-OP300 and OD-IV240 increased during the storage at 25° and 40°, while the concentration in OD-1P300 did not change for the storage.These results suggest that Iopamiron 300 is the most appropriate contrast medium which is combined with 01-damin for Injection among the 3 kinds of contrast media.