Safety and Efficacy of Modified BRTO-Assisted Endoscopic Histoacryl Injection for the Treatment of Isolated Gastric Varices with Gastro-Renal Shunt

Abstract

Background and Aims: Ectopic embolization is the most serious complication of gastric variceal Histoacryl injection for the treatment of Isolated Gastric Varices (IGV) with Gastro-Renal Shunt (GRS). To evaluate the safety and efficacy of modified balloon-occluded retrograde transvenous obliteration-assisted Endoscopic Histoacryl Injection (E-BRTO) for the treatment of IGV with GRS. Methods: Patients that had IGV with significant GRS, treated with E-BRTO, were included in this study. The GRS was temporarily occluded with an occlusion balloon and the IGV was treated by Endoscopic Histoacryl Injection using the “sandwich technique”. Intra- and postoperative complications as well as the IGV eradication, re-bleeding, and recurrence rates were recorded and analyzed. Results: 22 patients were included in this study. The mean volume of Histoacryl used was 16.57±11.76mL. No deaths or serious complications were observed, including ectopic embolism and the worsening of hepatic and renal functions. IGV were eradicated in 22 cases (100%). Abdominal pain and fever was observed in one patient (4.55%), recurrence and re-bleeding of IGV in one patient (4.55%), who was recovery by another Histoacryl injection. Conclusion: E-BRTO is technically feasible, safe, and effective for the treatment of IGV associated with GRS in cirrhotic patients and worthy of clinical application. Keywords: