Esophageal and Gastric Varices ; etiology ; therapy ; Female ; Gastrointestinal Hemorrhage ; etiology ; therapy ; Humans ; Liver Cirrhosis ; complications ; therapy ; Male

Malnutrition in patients with liver disease is common. Consequently, percutaneous endoscopic gastrostomy may be needed for the correction of malnutrition. Percutaneous endoscopic gastrostomy is rarely performed in patients with liver cirrhosis because of the presence of varices and coagulation abnormalities. However, if careful insertion technique along with thorough clinical assessment is undertaken, percutaneous endoscopic gastrostomy may be successfully performed in patients with liver cirrhosis. Here, we report successful application of percutaneous endoscopic gastrostomy in a patient with liver cirrhosis accompanied by both gastric and esophageal varices.
Aged ; *Endoscopy ; *Enteral Nutrition ; Esophageal and Gastric Varices/*complications ; Gastrostomy/*methods ; Humans ; Liver Cirrhosis/complications/*therapy ; Male

Esophageal and Gastric Varices ; etiology ; surgery ; Gastrointestinal Hemorrhage ; etiology ; therapy ; Hemostasis, Endoscopic ; Humans ; Hypertension, Portal ; complications

Esophageal and Gastric Varices ; etiology ; therapy ; Hemodynamics ; Humans ; Hypertension, Portal ; complications ; therapy ; Liver Cirrhosis ; complications ; therapy ; Portal Vein ; physiopathology

BACKGROUND/AIMS: Gastric variceal bleeding is difficult to treat endoscopically because the hemodynamics of the gastric varix are different from that of the esophageal varix. Transjugular intrahepatic portosystemic shunt (TIPS), which has been used widely, does not always result in the regression of gastric varix and it may aggravate the hepatic encephalopathy. Balloon occluded retrograde transvenous obliteration (BRTO) was introduced as a new procedure for gastric variceal bleeding with minimal invasiveness. The purpose of this study was to evaluate the therapeutic effects and complications on follow-up of BRTO as a new treatment option for gastric variceal bleeding. METHODS: Patients with gastric variceal bleeding, who were treated with BRTO form September, 2001 to April, 2003, were included in the study. After the definite confirmation of the shunts with abdominal CT, the sclerosing agent, 5% ethanolamine oleate, was injected into the gastric varix during occlusion through gastrorenal shunts. The procedurre was deemed a technical success when the clotting of the sclerosing agent was observed without leakage, and a clinical success when bleeding stopped and the varix decreased in size or was eradicated during the follow-up period (6-23 months, mean: 17.7). RESULTS: Technical success was achieved in 12 of 13 patients (92%) with gastric variceal bleeding. There were no significant side effects. In the one case of failure, the bleeding was controlled with TIPS. Eleven of the 12 patients who had technical success were shown to be clinically successful. The follow-up endoscopic exam showed some aggravation of pre-existing esophageal varices in four patients and a new development of esophageal varices in two patients. Endoscopic variceal ligation was done on one patient in whom esophageal variceal bleeding was present during the follow-up period. CONCLUSIONS: BRTO was proven to be a feasible, safe and less invasive procedure than TIPS and found to be an effective treatment of a gastric variceal bleeding. Considering the possible aggravation of pre-existing esophageal varices or the new development of esophageal varices, regular endoscopic examinations might be needed during the follow-up period.
Adult ; Aged ; *Balloon Occlusion ; English Abstract ; Esophageal and Gastric Varices/complications/*therapy ; Female ; Gastrointestinal Hemorrhage/etiology/*therapy ; Humans ; Male ; Middle Aged

Adult ; Aged ; Embolization, Therapeutic ; Esophageal and Gastric Varices ; complications ; therapy ; Female ; Gastrointestinal Hemorrhage ; etiology ; therapy ; Humans ; Male ; Middle Aged

OBJECTIVETo investigate the effect of enhanced nutritional therapy on wound healing after endoscopic therapy in patients with liver cirrhosis and esophageal varices.

METHODSFifty patients with liver cirrhosis and esophageal varices were randomly divided into an enhanced nutritional therapy group (n = 25) and a control group (n = 25). The enhanced nutritional therapy group received one week of enhanced nutritional supplementation, including liver nutritional elements, prior to routine endoscopic therapy. The routine without any change to their diet. The rate of transformation and status of wound healing of esophageal varices were compared between the two groups.

RESULTSThe ratio of ulcers occurring at the injection site was lower in the enhanced nutrition group than in the control group (16/25 vs. 23/25; x2 = 5.711, P = 0.017). The enhanced nutrition group had only one case of minimal bleeding occurring during endoscopy as compared to the seven cases of bleeding in the control group (x2 = 5.357, P = 0.021). On average, the enhanced nutrition group required less sessions of endoscopic treatment to achieve eradication of esophageal varices than the control group (3.8 vs. 4.1; t = 2.069, P = 0.044).

CONCLUSIONPre-endoscopic enhanced nutritional therapy may benefit patients with liver cirrhosis and esophageal varices by promoting recovery of procedure-related local tissue injury and occlusion of varices.

Adult ; Endoscopy ; Esophageal and Gastric Varices ; etiology ; therapy ; Female ; Humans ; Liver Cirrhosis ; complications ; therapy ; Male ; Middle Aged ; Nutritional Support ; Wound Healing

Endoscopy, Digestive System ; Esophageal and Gastric Varices ; complications ; drug therapy ; surgery ; therapy ; Fibrosis ; complications ; Gastrointestinal Hemorrhage ; drug therapy ; etiology ; surgery ; therapy ; Humans ; Hypertension, Portal ; drug therapy ; etiology ; surgery ; therapy

The creation of transjugular intrahepatic portosystemic shunt (TIPS) is a widely performed technique to relieve portal hypertension, and to manage recurrent variceal bleeding and refractory ascites in patients where medical and/or endoscopic treatments have failed. However, portosystemic shunt creation can be challenging in the presence of chronic portal vein occlusion. In this case report, we describe a minimally invasive endovascular mesocaval shunt creation with transsplenic approach for the management of recurrent variceal bleeding in a portal hypertension patient with intra- and extrahepatic portal vein occlusion.
Adolescent ; Chronic Disease ; Esophageal and Gastric Varices/complications ; Esophageal and Gastric Varices/diagnostic imaging ; Esophageal and Gastric Varices/therapy ; Female ; Gastrointestinal Hemorrhage/complications ; Gastrointestinal Hemorrhage/diagnostic imaging ; Gastrointestinal Hemorrhage/therapy ; Humans ; Jejunum/pathology ; Portacaval Shunt, Surgical ; Portal Vein/diagnostic imaging ; Portal Vein/pathology ; Portal Vein/surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Venous Thrombosis/complications ; Venous Thrombosis/diagnostic imaging ; Venous Thrombosis/therapy

PURPOSE: To evaluate the technical feasibility and safety of vascular plug assisted retrograde transvenous obliteration (PARTO) for bleeding gastric varix performed in the emergent clinical setting and describe the mid-term clinical results. MATERIALS AND METHODS: From April 2012 to January 2015, emergent PARTO was tried in total 9 patients presented with active gastric varix bleeding. After initial insufficient or failure of endoscopic approach, they underwent PARTO in the emergent clinical setting. Gelatin sponge embolization of both gastrorenal (GR) shunt and gastric varix was performed after retrograde transvenous placement of a vascular plug in GR shunt. Coil assisted RTO (CARTO) was performed in one patient who had challenging GR shunt anatomy for vascular plug placement. Additional embolic materials, such as microcoils and NBCA glue-lipiodol mixture, were required in three patients to enhance complete occlusion of GR shunt or obliteration of competitive collateral vessels. Clinical success was defined as no variceal rebleeding and disappearance of gastric varix. RESULTS: All technical and clinical success-i.e., complete GR shunt occlusion and offending gastric varix embolization with immediate bleeding control-was achieved in all 9 patients. There was no procedure-related complication. All cases showed successful clinical outcome during mean follow up of 17 months (12-32 months), evidenced by imaging studies, endoscopy and clinical data. In 4 patients, mild worsening of esophageal varices or transient ascites was noted as portal hypertensive related change. CONCLUSION: Emergent PARTO is technically feasible and safe, with acceptable mid-term clinical results, in treating active gastric varix bleeding.
Aged ; Ascites/complications ; Balloon Occlusion ; Embolization, Therapeutic ; *Emergency Medical Services ; Esophageal and Gastric Varices/*complications ; Feasibility Studies ; Female ; Gastrointestinal Hemorrhage/*complications/*therapy ; Humans ; Male ; Middle Aged