Top

European Radiology

Published in:

01-01-2011 | Interventional

Foam sclerotherapy using polidocanol for balloon-occluded retrograde transvenous obliteration (BRTO)

Authors: Sun Young Choi, Jong Yun Won, Kyung Ah Kim, Do Yun Lee, Kwang-Hun Lee

Published in: European Radiology | Issue 1/2011

Abstract

Purpose

To evaluate the clinical safety and effectiveness of foam sclerotherapy using polidocanol for the treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration (BRTO).

Materials and methods

From November 2005 to June 2009, foam sclerotherapy using polidocanol for the treatment of gastric fundal varices by BRTO was performed in 16 patients (male/female 11:5; age range 46–84 years, median 67 years). Foam was made of 3% polidocanol (Aethoxysklerol; Kreussler Pharma, Wiesbaden, Germany), room air, and contrast media, with a ratio of 1:2:1, respectively. The amount of polidocanol (2–24 mL; median 7 mL) depended on the volume of varices.

Results

Technical success was achieved in 15 of 16 patients (93.8%). Technical failure occurred in one patient. All patients were without pain during sclerotherapy. One patient experienced pulmonary edema after the procedure but completely recovered with medical treatment. There was no procedure-related mortality. Patients were followed by endoscopy, computed tomography, or both. Four patients were lost to follow-up. Clinical success was achieved in 10 of 11 patients (91%). Rebleeding occurred in one case during follow-up.

Conclusions

Foam sclerotherapy using polidocanol is clinically safe and effective for the treatment of gastric fundal varices during BRTO.

Trudeau W, Prindiville T (1986) Endoscopic injection sclerosis in bleeding gastric varices. Gastrointest Endosc 32:264–268CrossRefPubMed

Abdel-Wahab M, el-bidy G, Gad el-Hak N et al (1999) Fundal varices: problem and management. Hepatogastroenterology 46:849–854PubMed

Binmoeller KF, Borsatto R (2000) Variceal bleeding and portal hypertension. Endoscopy 32:189–199CrossRefPubMed

Keller FS, Dotter CT, Rosch J (1978) Percutaneous transhepatic obliteration of gastroesophageal varices: some technical aspects. Radiology 129:327–332PubMed

Henderson JM, Nagle A, Curtas S, Geisinger M, Barnes D (2000) Surgical shunts and TIPS for variceal decompression in the 1990s. Surgery 128:540–547. doi:10.1067/msy.2000.108209 CrossRefPubMed

Koconis KG, Singh H, Soares G (2007) Partial splenic embolization in the treatment of patients with portal hypertension: a review of the english language literature. J Vasc Interv Radiol 18:463–481. doi:10.1016/j.jvir.2006.12.734 CrossRefPubMed

Ou HY, Huang TL, Chen TY et al (2005) Emergency splenic arterial embolization for massive variceal bleeding in liver recipient with left-sided portal hypertension. Liver Transplant 11:1136–1139. doi:10.1002/lt.20543 CrossRef

Kanagawa H, Mima S, Kouyama H, Gotoh K, Uchida T, Okuda K (1996) Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol 11:51–58CrossRefPubMed

Matsumoto A, Hamamoto N, Nomura T et al (1999) Balloon-occluded retrograde transvenous obliteration of high risk gastric fundal varices. Am J Gastroenterol 94:643–649. doi:10.1111/j.1572-0241.1999.00928.x CrossRefPubMed

10.

Akahane T, Iwasaki T, Kobayashi N et al (1997) Changes in liver function parameters after occlusion of gastrorenal shunts with balloon-occluded retrograde transvenous obliteration. Am J Gastroenterol 92:1026–1030PubMed

11.

Koito K, Namieno T, Nagakawa T, Morita K (1996) Balloon-occluded retrograde transvenous obliteration for gastric varices with gastrorenal or gastrocaval collaterals. AJR Am J Roentgenol 167:1317–1320PubMed

12.

Sonomura T, Sato M, Kishi K et al (1998) Balloon-occluded retrograde transvenous obliteration for gastric varices: a feasibility study. Cardiovasc Interv Radiol 21:27–30CrossRef

13.

Hirota S, Matsumoto S, Tomita M, Sako M, Kono M (1999) Retrograde transvenous obliteration of gastric varices. Radiology 211:349–356PubMed

14.

Takahashi K, Yamada T, Hyodoh H et al (2001) Selective balloon-occluded retrograde sclerosis of gastric varices using a coaxial microcatheter system. AJR Am J Roentgenol 177:1091–1093PubMed

15.

Watanabe K, Kimura K, Matsutani S, Ohto M, Okuda K (1988) Portal hemodynamics in patients with gastric varices. A study in 230 patients with esophageal and/or gastric varices using portal vein catheterization. Gastroenterology 95:434–440PubMed

16.

Chikamori F, Kuniyoshi N, Shibuya S, Takase Y (2001) Correlation between endoscopic and angiographic findings in patients with esophageal and isolated gastric varices. Dig Surg 18:176–181CrossRefPubMed

17.

Kimura K, Ohto M, Matsutani S, Furuse J, Hoshino K, Okuda K (1990) Relative frequencies of portosystemic pathways and renal shunt formation through the “posterior” gastric vein: portographic study in 460 patients. Hepatology 12(4 Pt 1):725–728CrossRefPubMed

18.

Cho SK, Shin SW, Lee IH et al (2007) Balloon-occluded retrograde transvenous obliteration of gastric varices: outcomes and complications in 49 patients. AJR Am J Roentgenol 189:W365–W372. doi:10.2214/AJR.07.2266 CrossRefPubMed

19.

Hashizume M, Kitano S, Yamaga H, Sugimachi K (1988) Haptoglobin to protect against renal damage from ethanolamine oleate sclerosant. Lancet 2:340–341CrossRefPubMed

20.

Miyoshi H, Ohshiba S, Matsumoto A, Takada K, Umegaki E, Hirata I (1991) Haptoglobin prevents renal dysfunction associated with intravariceal infusion of ethanolamine oleate. Am J Gastroenterol 86:1638–1641PubMed

21.

Fukuda T, Hirota S, Sugimura K (2001) Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy. J Vasc Interv Radiol 12:327–336CrossRefPubMed

22.

Kitamoto M, Imamura M, Kamada K et al (2002) Balloon-occluded retrograde transvenous obliteration of gastric fundal varices with hemorrhage. AJR Am J Roentgenol 178:1167–1174PubMed

23.

Shimoda R, Horiuchi K, Hagiwara S et al (2005) Short-term complications of retrograde transvenous obliteration of gastric varices in patients with portal hypertension: effects of obliteration of major portosystemic shunts. Abdom Imaging 30:306–313. doi:10.1007/s00261-004-0270-8 CrossRefPubMed

24.

Kiyosue H, Mori H, Matsumoto S, Yamada Y, Hori Y, Okino Y (2003) Transcatheter obliteration of gastric varices. Part 1. Anatomic classification. Radiographics 23:911–920CrossRefPubMed

25.

Svoboda P, Kantorova I, Ochmann J, Kozumplik L, Marsova J (1999) A prospective randomized controlled trial of sclerotherapy vs ligation in the prophylactic treatment of high-risk esophageal varices. Surg Endosc 13:580–584CrossRefPubMed

26.

Ouvry P, Allaert FA, Desnos P, Hamel-Desnos C (2008) Efficacy of polidocanol foam versus liquid in sclerotherapy of the great saphenous vein: a multicentre randomised controlled trial with a 2-year follow-up. Eur J Vasc Endovasc Surg 36:366–370. doi:10.1016/j.ejvs.2008.04.010 CrossRefPubMed

27.

Hamel-Desnos C, Ouvry P, Benigni JP et al (2007) Comparison of 1% and 3% polidocanol foam in ultrasound guided sclerotherapy of the great saphenous vein: a randomised, double-blind trial with 2 year-follow-up. “The 3/1 Study”. Eur J Vasc Endovasc Surg 34:723–729, discussion 730. doi:10.1016/j.ejvs.2007.07.014 CrossRefPubMed

28.

Obara K, Sakamoto H, Kasukawa R (1991) Prediction of the recurrence of esophageal varices based on portal vein pressure and oxygen tension in portal and peripheral blood. Gastroenterol Jpn 26:707–711PubMed

29.

Hamel-Desnos C, Desnos P, Wollmann JC, Ouvry P, Mako S, Allaert FA (2003) Evaluation of the efficacy of polidocanol in the form of foam compared with liquid form in sclerotherapy of the greater saphenous vein: initial results. Dermatol Surg 29:1170–1175, discussion 1175CrossRefPubMed

30.

Huang YH, Yeh HZ, Chen GH et al (2000) Endoscopic treatment of bleeding gastric varices by N-butyl-2-cyanoacrylate (Histoacryl) injection: long-term efficacy and safety. Gastrointest Endosc 52:160–167. doi:10.1067/mge.2000.104976 CrossRefPubMed

31.

Ninoi T, Nishida N, Kaminou T et al (2005) Balloon-occluded retrograde transvenous obliteration of gastric varices with gastrorenal shunt: long-term follow-up in 78 patients. AJR Am J Roentgenol 184:1340–1346PubMed

32.

Kiyosue H, Mori H, Matsumoto S, Yamada Y, Hori Y, Okino Y (2003) Transcatheter obliteration of gastric varices: Part 2. Strategy and techniques based on hemodynamic features. Radiographics 23:921–937, discussion 937CrossRefPubMed

33.

Hong CH, Kim HJ, Park JH et al (2009) Treatment of patients with gastric variceal hemorrhage: endoscopic N-butyl-2-cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol 24:372–378. doi:10.1111/j.1440-1746.2008.05651.x CrossRefPubMed

34.

Choi YS, Lee JH, Sinn DH et al (2008) Effect of balloon-occluded retrograde transvenous obliteration on the natural history of coexisting esophageal varices. J Clin Gastroenterol 42:974–979. doi:10.1097/MCG.0b013e318126c154 CrossRefPubMed

35.

Redondo P, Cabrera J (2005) Microfoam sclerotherapy. Semin Cutan Med Surg 24:175–183. doi:10.1016/j.sder.2005.10.005 CrossRefPubMed

36.

Guex JJ (2005) Foam sclerotherapy: an overview of use for primary venous insufficiency. Semin Vasc Surg 18:25–29CrossRefPubMed

37.

Alos J, Carreno P, Lopez JA, Estadella B, Serra-Prat M, Marinel-Lo J (2006) Efficacy and safety of sclerotherapy using polidocanol foam: a controlled clinical trial. Eur J Vasc Endovasc Surg 31:101–107. 10.1016/j.ejvs.2005.08.018 CrossRefPubMed

38.

Frullini A, Cavezzi A (2002) Sclerosing foam in the treatment of varicose veins and telangiectases: history and analysis of safety and complications. Dermatol Surg 28:11–15CrossRefPubMed

39.

Kern P, Ramelet AA, Wutschert R, Bounameaux H, Hayoz D (2004) Single-blind, randomized study comparing chromated glycerin, polidocanol solution, and polidocanol foam for treatment of telangiectatic leg veins. Dermatol Surg 30:367–372, discussion 372CrossRefPubMed

40.

Breu FX, Guggenbichler S (2004) European Consensus Meeting on Foam Sclerotherapy, April, 4-6, 2003, Tegernsee, Germany. Dermatol Surg 30:709–717, discussion 717. doi:10.1111/j.1524-4725.2004.30209.x CrossRefPubMed

41.

Cho SK, Shin SW, Do YS et al (2008) Development of thrombus in the major systemic and portal veins after balloon-occluded retrograde transvenous obliteration for treating gastric variceal bleeding: its frequency and outcome evaluation with CT. J Vasc Interv Radiol 19:529–538. doi:10.1016/j.jvir.2007.10.012 CrossRefPubMed

42.

Barrett JM, Allen B, Ockelford A, Goldman MP (2004) Microfoam ultrasound-guided sclerotherapy of varicose veins in 100 legs. Dermatol Surg 30:6–12CrossRefPubMed

43.

Mimura H, Fujiwara H, Hiraki T et al (2009) Polidocanol sclerotherapy for painful venous malformations: evaluation of safety and efficacy in pain relief. Eur Radiol 19:2474–2480. doi:10.1007/s00330-009-1442-2 CrossRefPubMed

44.

Jain R, Bandhu S, Sawhney S, Mittal R (2002) Sonographically guided percutaneous sclerosis using 1% polidocanol in the treatment of vascular malformations. J Clin Ultrasound 30:416–423. doi:10.1002/jcu.10091 CrossRefPubMed

45.

Goldman MP (2002) Treatment of varicose and telangiectatic leg veins: double-blind prospective comparative trial between aethoxyskerol and sotradecol. Dermatol Surg 28:52–55CrossRefPubMed

46.

Marrocco-Trischitta MM, Guerrini P, Abeni D, Stillo F (2002) Reversible cardiac arrest after polidocanol sclerotherapy of peripheral venous malformation. Dermatol Surg 28:153–155CrossRefPubMed

47.

Arakaki Y, Murakami K, Takahashi K et al (2003) Clinical evaluation of combined endoscopic variceal ligation and sclerotherapy of gastric varices in liver cirrhosis. Endoscopy 35:940–945. doi:10.1055/s-2003-43475 CrossRefPubMed

48.

Kumagai Y, Makuuchi H, Yamazaki E (1987) Sclerotherapy of esophageal varices by consecutive injection of anhydrous ethanol: 1% polydocanol and thrombin. Surg Endosc 1:29–32CrossRefPubMed

49.

Sylvoz N, Villier C, Blaise S, Seinturier C, Mallaret M (2008) Polidocanol induced cardiotoxicity: a case report and review of the literature. J Mal Vasc 33:234–238. doi:10.1016/j.jmv.2008.09.004 CrossRefPubMed

50.

Escardo JC, Cosenza SJ, Alvarez JH, Pratesi P, Parra GG, Hita A (2007) Pulmonary embolism after sclerotherapy treatment for variceal bleeding. Endoscopy 39(Suppl 1):E24–E25. doi:10.1055/s-2006-944924 CrossRefPubMed

51.

Forlee MV, Grouden M, Moore DJ, Shanik G (2006) Stroke after varicose vein foam injection sclerotherapy. J Vasc Surg 43:162–164. doi:10.1016/j.jvs.2005.09.032 CrossRefPubMed

52.

Hanisch F, Muller T, Krivokuca M, Winterholler M (2004) Stroke following variceal sclerotherapy. Eur J Med Res 9:282–284PubMed

53.

Hartmann K, Harms L, Simon M (2009) Reversible neurological deficit after foam sclerotherapy. Eur J Vasc Endovasc Surg. doi:10.1016/j.ejvs.2009.06.022 PubMed

54.

Berde C, Strichartx G (2000) Anesthetics. Churchill Livingstone, Philadelphia

55.

Bernard PH, Lamouliatte H, Boulard A, Galperine I, Quinton A (1991) Reversible cardiac arrest after polidocanol endoscopic sclerotherapy of esophageal varices in infants. Gastroenterol Clin Biol 15:456–457PubMed

56.

Paterlini A, Salmi A, Buffoli F, Lombardi C (1984) Heart failure and endoscopic sclerotherapy of variceal bleeding. Lancet 1:1241CrossRefPubMed

57.

Idezuki Y (1995) General rules for recording endoscopic findings of esophagogastric varices (1991). Japanese Society for Portal Hypertension. World J Surg 19:420–422, discussion 423CrossRefPubMed

Title: Foam sclerotherapy using polidocanol for balloon-occluded retrograde transvenous obliteration (BRTO)
Authors: Sun Young Choi
Jong Yun Won
Kyung Ah Kim
Do Yun Lee
Kwang-Hun Lee
Publication date: 01-01-2011
Publisher: Springer-Verlag
Published in: European Radiology / Issue 1/2011
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-010-1895-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Foam sclerotherapy using polidocanol for balloon-occluded retrograde transvenous obliteration (BRTO)

Abstract

Purpose

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2011

Magnetic resonance imaging goes postmortem: noninvasive detection and assessment of myocardial infarction by postmortem MRI

Effect on renal function of an iso-osmolar contrast agent in patients with monoclonal gammopathies

Fibromatosis of the breast in a 52-year-old man (2010: 10b)

Pulmonary hemorrhage complicating radiofrequency ablation, from mild hemoptysis to life-threatening pattern

Tumour thickness in oral cancer using an intra-oral ultrasound probe

Conspicuity of breast cancer according to histopathological type and breast density when imaged by full-field digital mammography compared with screen-film mammography