Percutaneous Transhepatic Obliteration Research Articles

A case of early gastric cancer with esophagogastric varices safely treated with endoscopic submucosal dissection after percutaneous transhepatic obliteration and partial splenic embolization

A case of early gastric cancer with esophagogastric varices safely treated with endoscopic submucosal dissection after percutaneous transhepatic obliteration and partial splenic embolization

Percutaneous transhepatic obliteration with N-butyl-2-cyanoacrylate in a patient with a superior mesenteric vein intraluminal distal small bowel variceal bleed

Percutaneous transhepatic obliteration with N-butyl-2-cyanoacrylate in a patient with a superior mesenteric vein intraluminal distal small bowel variceal bleed

Successful Percutaneous Transhepatic Obliteration Plus Sengstaken-Blakemore Tube Combination Therapy for Recurrent Gastroesophageal Variceal Bleeding: A Case Report.

We treated a case of gastroesophageal varices due to decompensated liver cirrhosis associated with Wilson's disease. The varicose veins penetrated the paraesophageal vein. We performed endoscopic variceal ligation (EVL) on the perforating vein and endoscopic injection sclerotherapy (EIS) distally. However, 5 days after treatment, the patient vomited blood. Esophagogastroduodenoscopy showed bleeding from the ulcer after EVL at the perforating vein. We performed EVL and stopped the bleeding. However, the next day, she vomited blood again and developed hemorrhagic shock. We were able to achieve hemostasis and save the patient's life with combination therapy consisting of percutaneous transhepatic obliteration and Sengstaken-Blakemore tube placement.

Endoscopic variceal ligation and percutaneous transhepatic obliteration difficulty in esophageal variceal bleeding: a case report

A 48-year-old male patient with a history of alcoholic cirrhosis was admitted to our hospital due to hematemesis with a 7-day history of melena. Emergency esophagogastroduodenoscopy revealed esophageal variceal bleeding. We attempted hemostasis with endoscopic variceal ligation (EVL). The esophageal mucosa was not aspirated into the EVL device although the patient had no history of endoscopic injection sclerotherapy or EVL. Percutaneous transhepatic obliteration (PTO) was performed and esophageal variceal bleeding was successfully hemostasis. PTO is a viable option for refractory esophageal bleeding.

Efficacy of interventional radiology in the management of portal hypertension: A narrative review.

Portal hypertension is associated with numerous adverse effects, including the formation of gastroesophageal varices and a portal vein general circulation shunt. Portal hypertension can lead to portal blood flow into the liver and a subsequent reduction in liver function. Clinical interventions can be hampered by a concurrent reduction in circulating platelets associated with increased splenic activity. Pharmaceutical interventions for the treatment of complications associated with portal hypertension have achieved various degrees of success. However, an effective therapeutic strategy for portal hypertension has not yet been established. A literature search was performed using “PubMed.” Database between 1966 and January 2021 using the following keywords: portal hypertension, interventional radiology, balloon-occluded retrograde transvenous obliteration, transjugular retrograde obliteration of gastric varices, percutaneous transhepatic obliteration, partial splenic embolization, and transjugular intrahepatic portosystemic shunting. In this narrative review, we summarize the application of interventional radiology in patients with portal hypertension, including techniques for embolization of collateral veins and portal pressure reduction. These up-to-date interventional radiology techniques can be used to treat portal hypertension. The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Effectiveness of different coils for endovascular coiling for intractable hepatic encephalopathy caused by a portosystemic shunt.

Interventional radiology (IVR), including balloon-occluded retrograde transvenous obliteration (BRTO) and percutaneous transhepatic obliteration (PTO), is performed for patients with intractable hepatic encephalopathy (HE). However, information on the appropriate coil for endovascular coiling for preventing recanalization is lacking. This study aimed to compare the different types of coils for endovascular coiling used in BRTO and PTO for cases of intractable HE. This retrospective study included patients who underwent endovascular coiling with BRTO or PTO for HE caused by portosystemic shunts. The number of coils required for complete occlusion was compared among bare, fiber, and hydrogel-coated coils, and the expansion types that close the gap between and inside the hydrogel-coated coils were also compared. Of 38 patients (age range, 30-86 years), 16 and 22 underwent BRTO and PTO, respectively, using bare (19 patients), fiber (8 patients), and hydrogel-coated coils (10 patients; external expansion type, 4; internal expansion type, 6). No significant differences in the size of portosystemic shunts were observed according to the type of coil. The mean number of coils required for complete occlusion varied (bare coils, 19.32; fiber coils, 18.11; hydrogel-coated coils, 10.70). Significantly fewer coils were required for endovascular coiling with hydrogel-coated coils. In the internal expansion type, a mean of 8.5 coils was required for occlusion. In some patients who underwent portal vein embolization, complete occlusion was not achieved with the scheduled type of coil because of slight expansion of blood vessels due to coil pressure. The findings suggested that hydrogel-coated coils were effective in endovascular coiling for HE caused by a portosystemic shunt, and internal expansion-type hydrogel-coated coils may be effective for the first-line procedure.

Percutaneous transhepatic obliteration-related procedures for isolated gastric varices: experience of three cases.

Percutaneous transhepatic obliteration (PTO) can facilitate antegrade embolization of variceal veins. We herein report three patients who underwent percutaneous transhepatic sclerotherapy(PTS) or percutaneous transportal outflow-vessel-occluded sclerotherapy (PTOS) for isolated gastric varices. PTS was performed in Cases 1 and 2, and PTOS was performed in Case 3. Technical success was achieved in all patients without a decline in liver function; however, lack of a therapeutic benefit with rupture of esophageal varices occurred in Case 3. Case 3 had a history of pylorus gastrectomy plus Billroth-I reconstruction for gastric cancer and multiple feeding veins existed. PTO-related procedures are good treatment options for isolated gastric varices, but clinicians should be aware of the risk of treatment failure, especially the cases which have multiple feeding veins.

Combined approach for embolization of otherwise unmanageable gastric varices.

BackgroundThis study aimed to determine the feasibility, safety and effectiveness of combined percutaneous transhepatic obliteration (PTO) and balloon-occluded retrograde transvenous obliteration (BRTO) therapy for the treatment of patients with high-risk bleeding gastric varices.MethodsTen patients were retrospectively reviewed. All the patients presented gastric varices, according to the Sarin classification, at high risk of bleeding, and not otherwise manageable. Patients with portal vein thrombosis were excluded. All patients were treated with a combination of PTO and BRTO. In all cases the gastric varices were embolized with glue, combined with coils or not, with an occlusion balloon inflated into the shunt. In 7 cases, embolization was immediate; in the remaining 3 the balloon remained inflated for 4 h and in 2 of them embolization of the shunt was required. Technical success was defined as complete obliteration of the gastric varices observed during a contrast-enhanced computed tomography study and endoscopy within 1 month following treatment. Clinical success was defined as absence of bleeding of gastric varices during the follow-up period. Major and minor complications during the follow up were recorded.ResultsTwelve sessions of combined PTO and BRTO procedures were performed in 10 patients; in 2 patients a new combined treatment was required during the follow up. Technical and clinical success was 100%. Neither major nor minor procedure-related complications were observed.ConclusionCombined PTO and BRTO therapy is safe and effective for the treatment of gastric varices that cannot be managed otherwise.

A case of noncirrhotic hepatic encephalopathy due to porto-hepatic venous shunt successfully treated with percutaneous transhepatic obliteration

A case of noncirrhotic hepatic encephalopathy due to porto-hepatic venous shunt successfully treated with percutaneous transhepatic obliteration

A case of esophagojejunal varices rupture after proximal gastrectomy with double-tract reconstruction

BackgroundThe varices after proximal or total gastrectomy are uncommon because the supplying vessels are all divided. Emergent upper gastrointestinal endoscopy is the cornerstone of first-line management for the diagnosis and treatment of esophageal varices. However, there is no widely accepted standard strategy for esophagojejunal varices. We report a patient with esophagojejunal varices rupture 3 months after proximal gastrectomy treated with percutaneous transhepatic obliteration.Case presentationA 50-year-old man who had undergone proximal gastrectomy with double-tract reconstruction for esophagogastric junctional cancer 3 months before was admitted to the hospital due to gastrointestinal perforation. We performed emergency surgery and abdominal symptoms and inflammatory response improved postoperative. However, on POD3, he had eruptive bleeding at the just anal side of esophagojejunal anastomosis. Endoscopic clipping was unsuccessful because the mucosa was fragile and easily lacerated. Contrast-enhanced CT scan revealed the dilatation of the jejunal vein flowing into the ascending jejunal limb. Therefore, he was diagnosed as esophagojejunal varices rupture and percutaneous transhepatic obliteration (PTO) was tried for hemostasis. The portal and superior mesenteric veins were catheterized with the percutaneous transhepatic approach. Contrast agent injection into the jejunal branch demonstrated retrograde flow to the azygos vein through esophagojejunal varices. The microcatheter was inserted into the variceal blood supply branch and 10 mL of 5% ethanolamine oleate with iopamidol was injected. After obliteration therapy, the superior mesenteric venogram showed complete occlusion of the variceal supply branch. The patient was discharged from the hospital without any complications after 14 days.ConclusionPTO can be effective for gastroesophageal varices rupture with a dilated jejunal vein of the ascending limb, few supplying vessels, and little ascites.

US guided percutaneous direct obliteration and percutaneous transhepatic obliteration for wound varices after abdominal surgery: A case report

US guided percutaneous direct obliteration and percutaneous transhepatic obliteration for wound varices after abdominal surgery: A case report

A case report of bleeding from duodenal varices treated with percutaneous transhepatic obliteration

A case report of bleeding from duodenal varices treated with percutaneous transhepatic obliteration

Correction: Coil valve syndrome: a rare complication of percutaneous transhepatic obliteration successfully treated by argon plasma coagulation and double-balloon endoscopy.

Correction: Coil valve syndrome: a rare complication of percutaneous transhepatic obliteration successfully treated by argon plasma coagulation and double-balloon endoscopy.

Sustained viral response to direct acting antivirals in a decompensated HCV-related cirrhotic patient after both partial splenic embolization and percutaneous transhepatic obliteration for persistent hepatic encephalopathy

Sustained viral response to direct acting antivirals in a decompensated HCV-related cirrhotic patient after both partial splenic embolization and percutaneous transhepatic obliteration for persistent hepatic encephalopathy

A case of rectal varices treated with percutaneous transhepatic obliteration

A case of rectal varices treated with percutaneous transhepatic obliteration

PS01.080: A CASE REPORT OF JEJUNAL VARICEAL BLEEDING SUCCESSFULLY TREATED WITH PERCUTANEOUS TRANSHEPATIC OBLITERATION AFTER SURGERY OF ESOPHAGOGASTRIC JUNCTIONAL CARCINOMA

Abstract Background Varicose veins in the esophagogastric junction rarely occur after surgery of esophagogastric junctional carcinoma, because the collateral pathway of the left gastric vein and short gastric vein was sacrificed. We presented a case of jejunal variceal bleeding successfully treated with percutaneous transhepatic obliteration after surgery of esophagogastric junctional carcinoma. Methods Case report. Results A 50-year-old man with alcoholic liver cirrhosis (Child-B) was admitted for abdominal pain, three months after proximal gastrectomy for esophagogastric junctional carcinoma. After diagnosed with peritonitis due to jejunal perforation, emergency surgery was performed. The next day after surgery, he had developed a lot of black stool. Gastroduodenoscopy revealed the variceal bleeding at the anal side of the esophagojejunal anastomois. Although endoscopic clipping was performed, intermittent bleeding was observed for several days. Since the contrast-enhanced computed tomography scanning revealed jejunal vein dilation at the anal side of the esophagojejunal anastomois, we planned to perform percutaneous transhepatic obliteration. Percutaneous transhepatic portography revealed jejunal varices and drained to the inferior vena cava, and continuously obliterated by 5% EOI (Ethanolamine oleate iopamidol). He was discharged without re-bleeding on the 14th day after the obliteration. Conclusion Percutaneous transhepatic obliteration might be a useful treatment option for jejunal variceal bleeding after surgery of esophagogastric junctional carcinoma. Disclosure All authors have declared no conflicts of interest.

Abstract No. 619 Percutaneous transhepatic obliteration of bleeding rectal varices utilizing sodium tetradecyl sulfate foam and interlocking detachable coils: a single-center experience

Bleeding rectal varices are a rare but serious complication in patients with cirrhosis and portal hypertension. While medical and endoscopic approaches may be favored at many institutions, percutaneous transhepatic obliteration can be a safe and effective option, and an excellent adjunct or alternative to TIPS for select patients. We report our obliteration technique and clinical outcomes. This review was performed with institutional IRB approval. A retrospective review was performed of all cases at our institution from 2011 to 2017. A total of 5 transhepatic obliteration procedures were performed in 5 patients (3 male/2 female; mean age 60), 4 with active rectal variceal bleeding requiring transfusions and 1 with a history of recurrent rectal variceal bleeding episodes. MELD score was 0-10 in 3 patients, 11-20 in 1 patient, and >20 in 1 patient. In all patients, medical and endoscopic therapies were attempted unsuccessfully prior to variceal obliteration. All cases were performed using sodium tetradecyl sulfate foam and interlocking detachable coils from a percutaneous transhepatic approach. One patient underwent TIPS prior to variceal obliteration. Immediate postprocedural technical success, defined as the lack of continued opacification of rectal varices on postprocedural angiography, was 100%. One patient developed a right flank hematoma and small volume hemoperitoneum discovered at paracentesis on postprocedure-day 2 which did not require intervention. One patient was lost to follow-up following discharge. Over a median clinical follow-up time of 1 month, no patients required repeat endoscopic or endovascular intervention. One patient reported bleeding requiring hospitalization and transfusion at 4 months following the procedure, which subsequently resolved spontaneously. Percutaneous transhepatic obliteration is a safe and effective treatment for rectal varices related to cirrhosis and portal hypertension. Additional follow-up is needed to evaluate the longer-term efficacy for controlling and preventing bleeding.

Immediate efficacy of percutaneous transhepatic obliteration and sclerotherapy for giant pipeline esophageal varices hemorrhage in a patient with liver cirrhosis type C

Immediate efficacy of percutaneous transhepatic obliteration and sclerotherapy for giant pipeline esophageal varices hemorrhage in a patient with liver cirrhosis type C

Percutaneous transhepatic obliteration and percutaneous transhepatic sclerotherapy for intractable hepatic encephalopathy and gastric varices improves the hepatic function reserve.

Percutaneous transhepatic obliteration (PTO) and percutaneous transhepatic sclerotherapy (PTS) are widely performed as an emergency measure in cases of variceal hemorrhage and intractable hepatic encephalopathy. The PTO/PTS technique is capable of directly blocking the blood supply in cases in which balloon-occluded retrograde transvenous obliteration (B-RTO) is not effective, or in cases with complicated collateral flow. Although PTO/PTS is not currently the first choice due to the invasiveness of transhepatic puncture, this procedure can modify the blood flow in an antegrade manner. The present study examined the changes in hepatic function reserve following PTO/PTS for intractable hepatic encephalopathy and/or gastric varices. In total, the study included 37 patients (mean age, 61.75±12.77 years; age range, 32-88 years; male to female ratio, 23:14) with a variety of gastrorenal shunts, or B-RTO-intractable hepatic encephalopathy and gastric varices without gastrorenal shunts. The patients underwent PTO/PTS by embolizing a microcoil or injection of a sclerosing agent (5% ethanolamine oleate iopamidol). Alterations in hepatic function reserve prior to and following the procedure were compared. The patients were treated for hepatic encephalopathy in 11 patients, gastric varices in 19 patients, and both conditions in 7 patients. The results indicated that the blood ammonia level improved from 135.76±75.23 mg/dl to 88.00±42.16 and 61.81±33.75 mg/dl at 3 and 6 months after therapy, respectively. In addition, the Child-Pugh score improved from 8.48±2.01 prior to therapy to 7.70±1.84 and 7.22±2.01 at 3 and 6 months after the procedure, respectively. Although there was a concern that PTO/PTS may cause complications due to an increase in portal venous pressure (PVP) arising from shunt occlusion, no severe complications were observed. In conclusion, for patients with various gastrorenal shunts or those with B-RTO-intractable hepatic encephalopathy and gastric varices without gastrorenal shunts, PTO/PTS can improve the antegrade blood flow to the liver, as demonstrated by improvement in the hepatic function reserve.

胃静脈瘤と肝性脳症に対するPTO，B-RTOおよびそれらの併用療法（DBOE）の有用性に関する検討

胃静脈瘤と肝性脳症に対するPTO，B-RTOおよびそれらの併用療法（DBOE）の有用性に関する検討