ethamolin and Hypertension--Portal

Gastric varices (GVs) are a major complication of portal hypertension in patients with liver cirrhosis. The mortality rate associated with the bleeding from GVs is not low. Balloon-occluded retrograde transvenous obliteration (BRTO) was first introduced by Kanagawa et al. as a treatment for isolated GVs in 1994. It has been performed most frequently in Asia, especially in Japan. Ethanolamine oleate was the original sclerosant used in the therapy. Since the late 2000s, BRTO using sodium tetradecyl sulfate foam or polidocanol foam as a sclerosant has been performed in many countries other than Japan. Then, early in the 2010s, modified BRTO techniques including vascular plug-assisted retrograde transvenous obliteration and coil-assisted retrograde transvenous obliteration were developed as an alternative treatment for GVs. This article provides a historical overview of BRTO using various sclerosants and modified BRTO techniques, such as plug-assisted retrograde transvenous obliteration and coil-assisted retrograde transvenous obliteration.

Topics: Balloon Occlusion; Esophageal and Gastric Varices; Humans; Hypertension, Portal; Liver Cirrhosis; Oleic Acids; Polidocanol; Sclerosing Solutions; Sodium Tetradecyl Sulfate

The purpose of this review is to describe the clinical factors related to balloon-occluded retrograde transvenous obliteration, including the preparation needed, the technique and challenges, and the outcomes.. Although the procedure can be performed when transjugular intrahepatic portosystemic shunt is contraindicated or when endoscopic management fails, balloon-occluded retrograde transvenous obliteration is successful as a first-line or second-line therapy. Gastric variceal rebleeding rates are low and serious complications are rare. Randomized controlled trials are required to evaluate the superiority of this procedure over other methods of treating gastric varices and to determine which sclerosant should be used. In the near future, this procedure may play a larger role in emergency care and in the management of nongastric varices.

Topics: Balloon Occlusion; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Oleic Acids; Polidocanol; Polyethylene Glycols; Radiography, Interventional; Recurrence; Sclerosing Solutions; Sodium Tetradecyl Sulfate; Stomach; Tomography, X-Ray Computed; Vinblastine

The purpose of this paper is to describe our experience with endovascular obliteration of duodenal varices in patients with liver cirrhosis and portal hypertension. Balloon-occluded transvenous retrograde and percutaneous transhepatic anterograde embolizations were performed for duodenal varices in five patients with liver cirrhosis, portal hypertension, and decreased liver function. All patients had undergone previous endoscopic treatments that failed to stop bleeding and were poor surgical candidates. Temporary balloon occlusion catheters were used to achieve accumulation of an ethanolamine oleate-iopamidol mixture inside the varices. Elimination of the varices was successful in all patients. Retrograde transvenous obliteration via efferent veins to the inferior vena cava was enough to achieve adequate sclerosant accumulation in three patients. A combined anterograde-retrograde embolization was used in one patient with balloon occlusion of afferent and efferent veins. Transhepatic embolization through the afferent vein was performed in one patient under balloon occlusion of both efferent and afferent veins. There was complete variceal thrombosis and no bleeding was observed at follow-up. No major complications were recorded. Endovascular obliteration of duodenal varices is a feasible and safe alternative procedure for managing patients with portal hypertension and hemorrhage from this source.

Topics: Aged; Balloon Occlusion; Catheterization; Duodenum; Feasibility Studies; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Haptoglobins; Humans; Hypertension, Portal; Iopamidol; Liver Cirrhosis; Male; Middle Aged; Oleic Acids; Sclerosing Solutions; Treatment Outcome; Varicose Veins

The present study was conducted to compare usual sclerosants: polidocanol 1%, ethanolamine oleate 5% and the tissue adhesive: cyanoacrylate in the control of oesophageal variceal bleeding in Egyptian patients with portal hypertension in a prospective comparative trial. Sixty patients with portal hypertension due to schistosomal hepatic fibrosis and/or posthepatitic liver cirrhosis who had presented with acute oesophageal variceal bleeding were enrolled. Patients received balloon tamponade prior to injection were excluded. Resuscitation had been done before or during emergency endoscopy. Emergency endoscopy was conducted within 2 hours from the onset of hematemesis. Patients were immediately randomized during emergency endoscopy to receive polidocanol 1%, ethanolamine oleate 5% or tissue adhesive. Variceal rebleeding was managed by reinjection. The three groups were comparable for age, sex, etiology of portal hypertension, Child-Pugh class and findings at emergency endoscopy. No active bleeding was observed at the end of all injection sessions. Rebleeding had been occurred within the first 24 hours in 2 (10%) patients in polidocanol group and 3 (15%) patients in ethanolamine group (P > 0.05). Reinjection did control rebleeding in 2 (10%) patients in ethanolamine group with a total success rate of 95%. Exsanguinating rebleeding occurred in 2 (10%) patients in polidocanol group and one (5%) patient in ethanolamine group (P > 0.05). Postinjection large ulcers were diagnosed either in polidocanol (15%) or ethanolamine (10%) groups (P > 0.05). Other complications were minor and showed no significant differences between the three groups. In coclusion, polidocanol, ethanolamine and cyanoacrylate are equally safe and effective. For immediate endoscopic injection therapy an experienced team must be available.

Topics: Cyanoacrylates; Egypt; Esophageal and Gastric Varices; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Male; Oleic Acids; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions

We evaluated the efficacy and safety of balloon-occluded retrograde transvenous obliteration (B-RTO) performed using absolute ethanol with iodized oil (ET+LPD) and simultaneous endoscopic injection sclerotherapy (EIS) with cyanoacrylate (CA) for gastric varices (GVs).. A total of 16 patients with endoscopically proven high-risk GVs treated using combined B-RTO with ET+LPD and EIS with CA between January 2007 and July 2012 were enrolled.. Twelve cases included GVs involving both the cardia and fundus, two cases included fundal varices and two cases included cardiac varices. In terms of the form of GVs, 10 cases involved F2 lesions and six cases involved F3 lesions. The flow vein was the left gastric vein in 13 cases and the posterior gastric vein in three cases. The drainage route was a splenorenal shunt in all cases. The average dose of ET+LPD was 12.0 mL, while that of CA was 2.45 mL. All complications were transient, and no major complications occurred after the procedures. None of the patients experienced bleeding or recurrence of gastric varices after the combined B-RTO and EIS procedures during an average follow-up period of 38.3 months.. Combined B-RTO with ET+LPD and simultaneous EIS with CA is considered to be an effective and safe procedure for treating GVs.

Topics: Adult; Aged; Balloon Occlusion; Cyanoacrylates; Endoscopy, Gastrointestinal; Esophageal and Gastric Varices; Female; Gastric Fundus; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Injections, Intralesional; Male; Middle Aged; Oleic Acids; Recurrence; Risk Factors; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

We evaluated the respiratory effects of balloon-occluded retrograde transvenous obliteration (BRTO) performed for the treatment of gastric varices complicating liver cirrhosis.. From 2005 to 2009, we performed BRTO in 20 patients with gastric fundal varices, by intravariceal injection of 5% ethanolamine oleate (EO) as the sclerosant. We studied the effect of BRTO on the respiratory gas exchange, chest X-ray findings, computed tomography (CT) findings, pulmonary function parameters, and (99m) Tc-MAA lung perfusion scintigraphy findings. Subjects undergoing balloon-occluded retrograde transvenous varicerography (BRTV) without injection of the sclerosant served as the controls..   Arterial blood gas analysis revealed a decrease in the mean arterial partial oxygen tension (PaO(2)) (P < 0.01), and increase in the alveolar-arterial oxygen tension difference (AaDO(2)) after BRTO (P < 0.01), as compared with the results obtained before the BRTO, while breathing room air. No changes were observed after BRTV as compared with the previous findings. In addition, a significant correlation was observed between the change of the PaO(2) and the volume of the sclerosant injected (rs = 0.511, P = 0.011). Left-pleural effusion was noted on the chest CT in 20% of the patients. On pulmonary function testing, decrease of the vital capacity was noted in two of the 20 patients after BRTO.. The aforementioned results suggest that BRTO performed using EO as the sclerosant induces pulmonary function disorders. The effect was found to depend on the total amount of EO injected. Therefore, careful respiratory monitoring seems necessary in patients undergoing BRTO, particularly those in whom large volumes of the sclerosant are used.

Topics: Aged; Analysis of Variance; Balloon Occlusion; Case-Control Studies; Esophageal and Gastric Varices; Female; Humans; Hypertension, Portal; Injections, Intralesional; Japan; Liver Cirrhosis; Lung; Lung Diseases; Male; Middle Aged; Oleic Acids; Oxygen; Pleural Effusion; Pulmonary Gas Exchange; Sclerosing Solutions; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vital Capacity

A 75-year-old man with portal hypertension was referred to our institution because he suddenly began to pass a large amount of tarry stool. Arterial portography and computed tomography (CT) during arterial portography via the superior mesenteric artery, using a unified 64-slice multidetector row CT and angiography system, revealed bleeding ileal varices. The varices were supplied blood by a single ileal vein and drained by dilated veins in the abdominal wall. The bleeding was successfully arrested by performing percutaneous transhepatic sclerotherapy with 12 ml of 5% ethanolamine oleate. The blood flow to the varices was controlled by balloon occlusion, and microcoils were inserted into the varices and supplying vein. No complications or rebleeding occurred during the 13-month follow-up period, and CT images obtained during follow-up showed that the varices had disappeared.

Topics: Abdomen; Aged; Balloon Occlusion; Contrast Media; Diagnosis, Differential; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Ileum; Image Enhancement; Iopamidol; Male; Oleic Acids; Portography; Postoperative Complications; Reoperation; Sclerosing Solutions; Sclerotherapy; Tomography, X-Ray Computed; Treatment Outcome; Varicose Veins

Topics: Collateral Circulation; Contrast Media; Endoscopy, Gastrointestinal; Endosonography; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Iopamidol; Jejunum; Male; Middle Aged; Oleic Acids; Portasystemic Shunt, Transjugular Intrahepatic; Sclerosing Solutions; Sclerotherapy; Stents; Tomography, X-Ray Computed; Varicose Veins

Balloon-occluded retrograde transvenous obliteration (B-RTO) is an interventional radiologic technique that obliterates gastric fundal varices (GFV) from draining veins under balloon occlusion. Few reports have described the use of B-RTO in children. Here, we report a case of B-RTO in a 2-year-old female patient with isolated huge varices in the gastric fundus associated with portal hypertension after surgery for biliary atresia. There was no complication and thrombosis of the varices was achieved. Our results demonstrate that B-RTO is an efficacious and safe treatment for children with isolated GFV.

Topics: Balloon Occlusion; Contrast Media; Esophageal and Gastric Varices; Female; Gastric Fundus; Humans; Hypertension, Portal; Infant; Iopamidol; Oleic Acids; Radiography, Interventional; Sclerosing Solutions; Sclerotherapy

Balloon-occluded retrograde transvenous obliteration (B-RTO) is a new alternative treatment for gastric varices (GVx), but the long-term efficacy is not known. We investigated the long-term effects of B-RTO on rebleeding, prevention of first bleeding, mortality and occurrence of risky esophageal varices (EVx).. B-RTO was performed in 68 cirrhotic patients with GVx. Twenty patients had recent bleeding, transiently treated by endoscopic Histoacryl injection or balloon tamponade. Forty-eight patients had varices likely to bleed, but no bleeding. After B-RTO, the recurrent bleeding, occurrence of EVx and mortality over the long-term were evaluated.. B-RTO was successfully performed in 63 of 68 patients (92.6%). Varices eradication was confirmed by endoscopy in 61 of 63 patients (96.6%). During follow up, GVx bleeding occurred in two patients (3.2%). The 8-year cumulative rebleeding rates of patients with bleeding and risky GVx were 14% and 0%, respectively. Risky EVx occurred in 10 patients (17%) and the cumulative occurrence rate was 22% in 8 years. The cumulative occurrence rate of risky EVx was higher in GVx with EVx (GOV2-GVx) compared to GVx without EVx (IGV1, P < 0.05). No ectopic variceal bleeding occurred. No patients died from variceal bleeding. Hepatocellular carcinoma was the only significant prognostic factor (P < 0.05).. B-RTO is beneficial over the long-term, despite worsening EVx in some patients, because of excellent treatment efficacy and improved mortality. We believe that B-RTO can become a first-choice radical treatment following hemostasis for gastric variceal bleeding and prophylactic treatment for risky GVx.

Topics: Adult; Aged; Balloon Occlusion; Enbucrilate; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Gastroscopy; Hemostatic Techniques; Humans; Hypertension, Portal; Kaplan-Meier Estimate; Liver Cirrhosis; Male; Middle Aged; Oleic Acids; Phlebography; Recurrence; Risk Assessment; Sclerosing Solutions; Sclerotherapy; Time Factors; Tissue Adhesives; Treatment Outcome

The feasibility of infusion of 50% glucose solution before balloon-occluded retrograde transvenous obliteration (BRTO) to occlude collateral vessels draining gastric varices other than gastrorenal shunt was evaluated. In five patients with such collateral vessels, 50% glucose solution was infused from the balloon catheter inflated within the gastrorenal shunt. The degree of collateral vessels had decreased when BRTO was carried out so that sclerotic agents sufficiently occupied the gastric varices in all patients. In three patients, embolization of collateral vessels with coils was unnecessary. There were no complications. In conclusion, retrograde infusion of 50% glucose solution assists in effectively carrying out BRTO.

Topics: Aged; Balloon Occlusion; Collateral Circulation; Esophageal and Gastric Varices; Feasibility Studies; Glucose; Humans; Hypertension, Portal; Male; Middle Aged; Oleic Acids; Sclerosing Solutions; Treatment Outcome

This is a prospective study, carried out in patients with portal hypertension and bleeding oesophageal varices secondary to Symmers (Schistosomal) periportal fibroses, to determine the efficacy of sclerotherapy, the number of sessions needed to achieve full sclerosis, the complications associated with sclerotherapy and the incidence and risk factors for rebleeding. In total, 85 patients were studied with a mean age of 38 years, 76.5% were males. All underwent upper gastrointestinal endoscopy, had different grades of oesophageal varices and underwent intravariceal injection with 5% ethanolamine oleate until they achieved full sclerosis or were referred to surgery. Complications of sclerotherapy included oesophageal strictures, deep oesophageal ulcers, pleural effusion and ascites. Following obliteration of oesophageal varices, 3.5% and 20% developed new gastric varices and portal gastropathy, respectively. Rebleeding occurred in 32% - the only significant predictive risk factor for which was patients with GIII varices following the first sclerotherapy session. Varices recurred in 6% of patients after a mean follow-up period of one year. In total, 93% of our patients achieved full sclerosis after an average of four sessions, and 3.5% were referred for surgery. Three patients (3.5%) died, all from massive rebleeding. In conclusion, sclerotherapy is a safe effective method for treating patients with oesophageal varices due to periportal fibroses.

Topics: Adult; Animals; Cross-Sectional Studies; Endoscopy; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Incidence; Male; Oleic Acids; Portal Vein; Prevalence; Prospective Studies; Recurrence; Schistosomiasis mansoni; Sclerosing Solutions; Sclerotherapy; Splenic Vein; Sudan

Caput medusa is a frequent incidental finding in patients with portal hypertension that usually represents paraumbilical vein portosystemic collateral vessels draining into body wall systemic veins. A symptomatic caput medusa was seen in a morbidly obese patient after an umbilical hernia repair, which was fed not by the left portal vein but by the left gastroepiploic vein, in a recurrent adhesed umbilical hernia that likely contained herniated omentum. Refractory hemorrhage from this caput medusa was successfully treated by transjugular intrahepatic portosystemic shunt creation and balloon-occluded variceal sclerosis.

Topics: Hemorrhage; Hernia, Umbilical; Humans; Hypertension, Portal; Male; Middle Aged; Oleic Acids; Omentum; Peritoneal Diseases; Portasystemic Shunt, Transjugular Intrahepatic; Postoperative Complications; Recurrence; Sclerosing Solutions; Sclerotherapy; Stomach; Tissue Adhesions; Varicose Veins

The safety and efficacy of poly-N-acetyl glucosamine (p-GlcNAc) gels were compared with standard agents in three different dog studies to assess abdominal venous collaterals, bleeding esophageal varices, and bleeding gastric varices.. Adult dogs with prehepatic portal hypertension and large abdominal venous collaterals, esophageal varices, or gastric varices were studied.. Significantly higher sclerosis rates were seen with F2 or F4 p-GlcNAc gels and standard sclerosants. F2 and F4 gels had high rates of permanent hemostasis, low rates of secondary ulceration, and significant reductions in esophageal and gastric variceal size. These results were either equivalent to or significantly better than the most commonly used gastric varix hemostatic agent (glue) or other sclerosing agents.. F2 and F4 poly-N-acetyl glucosamine gels are promising therapeutic agents for venous and variceal hemostasis.

Topics: Acetylglucosamine; Alcohols; Animals; Chemistry, Pharmaceutical; Disease Models, Animal; Dogs; Double-Blind Method; Drug Evaluation, Preclinical; Enbucrilate; Esophageal and Gastric Varices; Esophagoscopy; Gastrointestinal Hemorrhage; Gastroscopy; Gels; Hemostatic Techniques; Hemostatics; Hypertension, Portal; Oleic Acids; Random Allocation; Sclerosing Solutions; Sclerotherapy; Sodium Morrhuate; Wound Healing

Topics: Catheterization; Duodenal Diseases; Female; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Iopamidol; Jugular Veins; Middle Aged; Oleic Acids; Sclerosing Solutions

We report a case of Cruveihier-Baumgarten syndrome associated with portal vein thrombosis that developed, slowly during a 2-year period after endoscopic variceal sclerotherapy. The thrombosis led to the disappearance of the venous hum and the dilated abdominal wall veins characteristic of this syndrome. A 73-year-old woman was hospitalized for treatment of esophageal varices in April 1988. Her spleen was markedly enlarged, and the histologic findings of her liver were not consistent with hepatic cirrhosis, but with idiopathic portal hypertension. A venous hum was audible in the upper abdomen. Superior mesenteric angiography revealed a porto-systemic shunt vessel under the abdominal wall, originating from the umbilical vein. She was injected four times with a sclerosant, and this brought about disappearance of the esophageal varices. Two years after the first admission, the venous hum was no longer audible, but there was a recurrence of the esophageal varices. More than 2 years later (4 years after the first admission), ultasonographic study, computed tomography, and angiography showed a large thrombus, which completely obstructed the portal vein at the origin of the umbilical vein, and the development of collateral vessels, seen as a "cavernous transformation."

Topics: Aged; Auscultation; Collateral Circulation; Esophageal and Gastric Varices; Female; Hemostasis, Endoscopic; Humans; Hypertension, Portal; Oleic Acids; Portal Vein; Recurrence; Sclerosing Solutions; Thrombosis; Time Factors

The authors report a 15-year experience with injection sclerotherapy in the management of adult and teenage patients with esophageal varices due to extrahepatic portal venous obstruction (EHPVO).. Extrahepatic portal venous obstruction is an uncommon cause of esophageal varices and is associated with normal liver function. Effective control of variceal bleeding is the major factor influencing survival. The results of surgery have been unsatisfactory, and therefore, more conservative management policies have been adopted.. Fifty-five patients with proven EHPVO underwent repeated injection sclerotherapy via either a modified rigid esophagoscope under general anaesthesia or a fiber-optic endoscope under light sedation, using ethanolamine oleate as the sclerosant.. Esophageal varices were eradicated in 44 patients after a median number 6 injections (range 1-17) over a mean of 12.5 months (range 1-48). The mean follow-up was 6.8 years (range 1.1-14.6 years). Eleven patients were admitted on eighteen occasions with bleeding from esophageal varices before eradication and there were seven bleeding episodes in six patients from recurrent varices after initial eradication. Complications related to sclerotherapy included injection site leak (6), stenosis (11) and mucosal ulceration (32) during 362 injection sclerotherapy episodes. Four patients died during the study period.. Injection scelotherapy is the treatment of choice in most patients with EHPVO.

Topics: Adult; Constriction, Pathologic; Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Hypertension, Portal; Male; Oleic Acids; Portal Vein; Recurrence; Sclerosing Solutions; Sclerotherapy; Time Factors

Esophageal varices in 57 consecutive children were treated by injection sclerotherapy using 5% ethanolamine oleate injection via a fiberoptic endoscope (Olympus P2). Variceal obliteration was achieved with 4.7 and 5.7 injections in the extra- and intrahepatic disease groups. Complications of injections included hemorrhage, esophageal ulceration, and stricture. Thirty two cases were followed from 6 to 60 months after treatment and only five further bleeds were observed (extrahepatic 1: intrahepatic 4). The early results suggest that sclerotherapy is an effective method for the control of esophageal varices in children.

Topics: Adolescent; Child; Child, Preschool; Esophageal and Gastric Varices; Esophageal Diseases; Esophagoscopy; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Infant; Injections; Male; Oleic Acids; Sclerosing Solutions