Jun Koizumi MD, PhD, Presenter: Nothing to Disclose

Tatsuya Sekiguchi, Abstract Co-Author: Nothing to Disclose

Tamaki Ichikawa MD, Abstract Co-Author: Nothing to Disclose

Chihiro Itou, Abstract Co-Author: Nothing to Disclose

Takuya Hara MD, Abstract Co-Author: Nothing to Disclose

Bertrand Janne d'Othee MD, MPH, Abstract Co-Author: Nothing to Disclose

Liquid ethanolamine oleate which has been used traditionally for balloon-occluded retrograde transvenous obliteration (BRTO) of the gastric varices (GV) may cause severe complications including hemolysis, allergy, etc. if overdosed. Thus, we introduced foam sclerotherapy to reduce the dose and compared the safety and efficacy of BRTO using liquid and foam sclerosants.

Forty three patients with gastric varices were performed BRTO since October ‘01. Of these, three patients were excluded because simultaneous TACE or PSE was performed. Twenty patients using liquid ethanolamine oleate with iodine contrast (EOI, Fig.1) before March ’05 and twenty patients using polidocanol foam (POF, Fig.2) after May ’05 were included in this study. The success rates, side effects and complication rates were compared among the two groups.

Complete stasis of the gastric varices was obtained in all patients of both groups. Abdominal symptoms during BRTO were significantly (p<0.05) higher in EOI (55%) than POF (15%). Postprocedure fever (>38.0) was also significantly (p<0.01) higher in EOI (55%) than in POF (0%). In both groups total bilirubin increased and platelet counts decreased significantly (p<0.01). However, the decrease ratio of platelet counts was significantly (p<0.05) higher in EOI (-21.1±15.8%) than POF (–9.4±13.1%). Although lactate dehydronase increased significantly (p<0.01) from 366.1±168.2 to 969.4±420.7 in EOI group, it was stable (from 229.7±36.5 to 244.6±86.5) in POF group. One patient died of ARDS one week after BRTO using EOI.

Foam polidocanol provided less invasive BRTO than liquid ethanolamine oleate with comparative clinical success.

EOI which is traditionally used in BRTO may cause hemolysis and require haptoglobin. In the U.S. EOI is now replaced by foam sclerosant This comparative study supports safer properties of foam.

Koizumi, J, Sekiguchi, T, Ichikawa, T, Itou, C, Hara, T, Janne d'Othee, B, The Comparison of Balloon-occluded Retrograde Transvenous Obliteration for Gastric Varices Using Liquid and Foam Sclerosants.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13017560.html