1.Endoscope therapy of bleeding in portal hypertension.
Chinese Journal of Surgery 2008;46(22):1696-1698
3.Management of variceal hemorrhage: current status.
Chinese Medical Journal 2009;122(7):763-765
4.Mesocaval Shunt Creation for Jejunal Variceal Bleeding with Chronic Portal Vein Thrombosis
Ja Kyung YOON ; Man Deuk KIM ; Do Yun LEE ; Seok Joo HAN
Yonsei Medical Journal 2018;59(1):162-166
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
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Chronic Disease
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Esophageal and Gastric Varices/complications
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Esophageal and Gastric Varices/diagnostic imaging
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Esophageal and Gastric Varices/therapy
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Female
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Gastrointestinal Hemorrhage/complications
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Gastrointestinal Hemorrhage/diagnostic imaging
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Gastrointestinal Hemorrhage/therapy
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Humans
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Jejunum/pathology
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Portacaval Shunt, Surgical
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Portal Vein/diagnostic imaging
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Portal Vein/pathology
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Portal Vein/surgery
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Tomography, X-Ray Computed
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Treatment Outcome
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Venous Thrombosis/complications
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Venous Thrombosis/diagnostic imaging
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Venous Thrombosis/therapy
6.Balloon Occlusion Retrograde Transvenous Obliteration of Gastric Varices in Two Non-Cirrhotic Patients with Portal Vein Thrombosis.
Peyman BORGHEI ; Seung Kwon KIM ; Darryl A ZUCKERMAN
Korean Journal of Radiology 2014;15(1):108-113
This report describes two non-cirrhotic patients with portal vein thrombosis who underwent successful balloon occlusion retrograde transvenous obliteration (BRTO) of gastric varices with a satisfactory response and no complications. One patient was a 35-year-old female with a history of Crohn's disease, status post-total abdominal colectomy, and portal vein and mesenteric vein thrombosis. The other patient was a 51-year-old female with necrotizing pancreatitis, portal vein thrombosis, and gastric varices. The BRTO procedure was a useful treatment for gastric varices in non-cirrhotic patients with portal vein thrombosis in the presence of a gastrorenal shunt.
Adult
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Balloon Occlusion/*methods
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Crohn Disease/surgery
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Esophageal and Gastric Varices/*therapy
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Female
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Humans
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*Mesenteric Veins
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Middle Aged
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Pancreatitis, Acute Necrotizing/complications
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*Portal Vein
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Venous Thrombosis/*complications
7.Comparison of Terlipressin and Octreotide with Variceal Ligation for Controlling Acute Esophageal Variceal Bleeding: a Randomized Prospective Study.
Sung Bum CHO ; Kang Jin PARK ; Jung Soo LEE ; Wan Sik LEE ; Chang Hwan PARK ; Young Eun JOO ; Hyun Soo KIM ; Sung Kyu CHOI ; Jong Sun REW ; Sei Jong KIM
The Korean Journal of Hepatology 2006;12(3):385-393
BACKGROUND/AIMS: Terlipressin and octreotide had been used to control acute variceal bleeding and to prevent early rebleeding after endoscopic hemostasis. We compared the efficacy and safety of terlipressin and octreotide combined with endoscopic variceal ligation (EVL) for the treatment of acute esophageal variceal bleeding and we evaluated their clinical significance as related to rebleeding. METHODS: The eighty eight cirrhotic patients were randomized to the terlipressin group (n=43; 2 mg i.v. initially and 1 mg i.v. at every 4 hours for 3 days) or the octreotide group (n=45; continuous infusion of 25 microgram/h for 5 days) combined with EVL for the treatment of acute esophageal variceal bleeding. RESULTS: The initial hemostasis rates were 98% (42/43 cases) in the terlipressin group and 96% (43/45 cases) in the octreotide group. The 5-day and 42-day rebleeding rates were 12% (5/43 cases) and 28% (12/43 cases), respectively, in the terlipressin group and 9% (4/45 cases) and 24% (11/45 cases), respectively, in the octreotide group. No significant difference was demonstrated between the terlipressin and octreotide groups. The mortality at 42 days was similar in both group, but a high mortality rate (48%) was shown to be related to 42-day rebleeding. The risk factors related to 42-day rebleeding were Child-Pugh class C (aOR=30.2, 95% CI=7.7-117.9), ascites above grade II (aOR=6.6, 95% CI=2.2-19.2) and advanced hepatocellular carcinoma (aOR=4.6, 95% CI=1.1-18.9). CONCLUSIONS: Comparing terlipressin and octreotide combined with EVL showed them to be equally safe and effective therapeutic agents in patients with acute esophageal variceal bleeding. The high risk factors related to early rebleeding were poor liver function and advanced hepatocellular carcinoma.
Acute Disease
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Aged
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Esophageal and Gastric Varices/drug therapy/surgery/*therapy
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Female
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Gastrointestinal Hemorrhage/drug therapy/surgery/*therapy
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Humans
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Liver Cirrhosis/drug therapy/surgery/*therapy
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Lysine Vasopressin/*analogs & derivatives/therapeutic use
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Male
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Middle Aged
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Octreotide/*therapeutic use
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Vasoconstrictor Agents/*therapeutic use
8.N-Butyl Cyanoacrylate Embolization with Blood Flow Control of an Arterioportal Shunt That Developed after Radiofrequency Ablation of Hepatocellular Carcinoma.
Tetsuo SONOMURA ; Nobuyuki KAWAI ; Kazushi KISHI ; Akira IKOMA ; Hiroki SANDA ; Kouhei NAKATA ; Hiroki MINAMIGUCHI ; Motoki NAKAI ; Seiki HOSOKAWA ; Hideyuki TAMAI ; Morio SATO
Korean Journal of Radiology 2014;15(2):250-253
We present a case of a patient with rapid deterioration of esophageal varices caused by portal hypertension accompanied by a large arterioportal shunt that developed after radiofrequency ablation of hepatocellular carcinoma. We used n-butyl cyanoacrylate (NBCA) as an embolic material to achieve pinpoint embolization of the shunt, because the microcatheter tip was 2 cm away from the shunt site. Under hepatic arterial flow control using a balloon catheter, the arterioportal shunt was successfully embolized with NBCA, which caused an improvement in the esophageal varices.
Aged
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Arteriovenous Fistula/etiology/radiography/*therapy
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Carcinoma, Hepatocellular/*surgery
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Catheter Ablation/*adverse effects
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Embolization, Therapeutic/*methods
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Enbucrilate/*therapeutic use
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Esophageal and Gastric Varices/etiology/*therapy
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Hepatic Artery/*abnormalities/radiography
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Humans
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Liver Neoplasms/*surgery
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Male
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Portal Vein/*abnormalities/radiography
9.A Case of Successful Treatment of Stomal Variceal Bleeding with Transjugular Intrahepatic Portosystemic Shunt and Coil Embolization.
Seo Goo HAN ; Ki Jun HAN ; Hyeon Geun CHO ; Chang Woo GHAM ; Chang Hwan CHOI ; Sang Yon HWANG ; Soon Young SONG
Journal of Korean Medical Science 2007;22(3):583-587
Variceal bleeding from enterostomy site is an unusual complication of portal hypertension. The bleeding, however, is often recurrent and may be fatal. The hemorrhage can be managed with local measures in most patients, but when these fail, surgical interventions or portosystemic shunt may be required. Herein, we report a case in which recurrent bleeding from stomal varices, developed after a colectomy for rectal cancer, was successfully treated by placement of transjugular intrahepatic portosystemic shunt (TIPS) with coil embolization. Although several treatment options are available for this entity, we consider that TIPS with coil embolization offers minimally invasive and definitive treatment.
Colectomy/adverse effects
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Contrast Media/pharmacology
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Embolization, Therapeutic/*methods
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Esophageal and Gastric Varices/surgery
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Gastrointestinal Hemorrhage/*therapy
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Humans
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Male
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Middle Aged
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*Portasystemic Shunt, Transjugular Intrahepatic
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Rectal Neoplasms/surgery
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Tomography, X-Ray Computed/methods
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Treatment Outcome
10.Therapeutic Effect of the Endoscopic N-butyl-2-cyanoacrylate Injection for Acute Esophagogastric Variceal Bleeding: Comparison with Transjugular Intrahepatic Portosystemic Shunt.
Du Young NOH ; Sun Young PARK ; So Young JOO ; Chang Hwan PARK ; Wan Sik LEE ; Young Eun JOO ; Hyun Su KIM ; Sung Kyu CHOI ; Jong Sun REW ; Sei Jong KIM
The Korean Journal of Gastroenterology 2004;43(3):186-195
BACKGROUND/AIMS: Though endoscopic therapies such as variceal ligation and sclerotherapy has been performed, bleeding from the large esophageal and gastric varices still poses significant risk of death. Decrease of portal pressure by TIPS (transjugular intrahepatic portosystemic shunt) or surgical shunt was indicated as cause of failure of endoscopic therapies. Treatment of N-butyl-2-cyanoacrylate has been especially effective for gastric variceal bleeding, but comparison with other treatments had not been reported yet. In this study, the effect of cyanoacrylate injection therapy was cross-examined with the result of TIPS in acute esophagogastric variceal bleedings. METHODS: From April 1995 to June 2002, endoscopic cyanoacrylate injection therapy (43 cases) and TIPS (63 cases) were performed in our hospital. Each group was analysed regarding their clinical results including initial hemostasis rate, rebleeding rate, survival duration, mortality and morbidity. RESULTS: Initial hemostasis rate was 95.3% in cyanoacrylate group and 92.1% in TIPS group. Cumulative probability of rebleeding was not different between two groups. Overall complication rates associated with the procedure were 50.8% in TIPS group and 9.3% in cyanoacrylate group. There was no significant difference between two groups in their survival rates. CONCLUSIONS: Cyanoacrylate injection therapy was relatively safe, and has comparable results with TIPS for uncontrollable and severe esophagogastric variceal bleedings.
Acute Disease
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Comparative Study
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Enbucrilate/*administration & dosage/*analogs & derivatives
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Endoscopy, Digestive System
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English Abstract
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Esophageal and Gastric Varices/surgery/*therapy
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Female
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Gastrointestinal Hemorrhage/*therapy
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*Hemostasis, Endoscopic
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Humans
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Injections
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Male
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Middle Aged
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*Portasystemic Shunt, Transjugular Intrahepatic
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Tissue Adhesives/*administration & dosage